Correlation between plasma trimethylamine-N-oxide and coronary heart disease and its effect on the prognosis of patients with coronary heart disease

Objective To investigate the correlation between trimethylamine-N-oxide (TMAO) and coronary heart disease (CHD) and its impact on the prognosis of patients with CHD.

Methods From May 2019 to December 2020, 200 CHD patients who underwent coronary angiography (CHD group) and 124 healthy subjects with negative coronary angiography or coronary CT results (control group) were selected. The level of TMAO was determined by high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). According to the median plasma TMAO value of 3.14 μmol/L, the CHD group was divided into group A(low TMAO CHD group) and group B (high TMAO CHD group). Gensini score was used to evaluate the degree of coronary artery disease. The levels of TMAO in the control group and CHD group were analyzed, and the correlation between the degree of coronary artery disease and TMAO level was analyzed. The influencing factors of CHD and TMAO were analyzed by logistic regression. Patients with CHD were followed up for 1 year, death, myocardial infarction, revascularization and other adverse events were recorded. Kaplan-Meier survival and risk curves were drawn to further compare the incidence of adverse events between the group A and group B.

Results The level of TMAO in the CHD group was significantly higher than that in the control group (P=0.001). High TMAO level was a risk factor for CHD (OR=7.54, 95%CI, 4.27 to 13.33, P < 0.001); in patients with CHD, high body mass index (BMI) was a risk factor for elevated TMAO (OR=1.48, 95%CI, 1.09 to 2.00, P=0.001). The Gensini score of the group A was significantly lower than that of the group B (P < 0.05). Serum TMAO level in CHD patients was positively correlated with Gensini score (r=-0.449, P < 0.001). There was a significant difference in survival curve between the group A and group B (P=0.005). In group B, the survival rate decreased and the hazard rate increased.

Conclusion TMAO is one of the influencing factors for CHD, and the severity of lesions and cardiovascular adverse events in CHD patients are related to TMAO level. TMAO can be used as a diagnostic and prognostic marker for CHD.