BACKGROUND Previous clinical studies have suggested that trimethylamine-N-oxide (TMAO) could contribute to the development of atherosclerosis cardiovascular disease. However, the synthetic analysis in coronary heart disease (CHD) was not yet performed. We aimed to clarify the relationship between elevated plasma concentrations of TMAO and the incidence of major adverse cardiovascular events (MACE) in CHD patients. METHODS Meta-analysis and dose-response analysis of hazard ratio data from prospective observational studies reporting on the association between TMAO plasma concentrations and the incidence of MACE in patients with CHD were conducted. RESULTS Of the 2369 published articles identified in the search, seven papers, with data from nine cohort studies (10,301 patients), were included in the meta-analysis. Combined data showed that elevated plasma TMAO concentrations could increase 58% higher risk of MACE in patients with CHD (hazard ratios [HR]: 1.58; 95% confidence interval [CI] = 1.35-1.84, P = 0.000). For follow-up ≥ 1 year, it was associated with 62% higher risk of MACE in patients with longer-term than shorter-term (HR for follow-up ≥ 4 years: 1.96; 95% CI = 1.52-2.52 vs one to 3 years: 1.34; 95% CI = 1.26-1.43, P = 0.004). The dose-response analysis revealed a 'J' shaped association between TMAO concentration and the incidence of MACE (P = 0.033), with the concentration above 5.1 μmol/L being associated with HR of > 1. CONCLUSIONS Elevated levels of TMAO are associated with an increased incidence of MACE in patients with CHD. TMAO concentration of 5.1 μmol/L may be a cut-off value for prognosis.

中文翻译：

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三甲胺-N-氧化物在冠心病中具有预后价值：荟萃分析和剂量反应分析。

背景技术以前的临床研究表明三甲胺-N-氧化物（TMAO）可能有助于动脉粥样硬化心血管疾病的发展。但是，尚未进行冠心病（CHD）的综合分析。我们的目的是弄清冠心病患者血浆中TMAO浓度升高与主要不良心血管事件（MACE）发生率之间的关系。方法对前瞻性观察性研究报告了冠心病患者TMAO血药浓度与MACE发生率之间的相关性，对危险比数据进行了荟萃分析和剂量反应分析。结果在检索中确定的2369篇发表的文章中，荟萃分析包括7篇论文，其中包括9项队列研究（10,301例患者）的数据。合并数据显示，升高的血浆TMAO浓度可使冠心病患者的MACE风险增加58％（危险比[HR]：1.58； 95％置信区间[CI] = 1.35-1.84，P = 0.000）。对于随访≥1年的患者，长期与短期相比，其发生MACE的风险增加62％（随访≥4年的HR：1.96； 95％CI = 1.52-2.52 vs. 3年：1.34； 95％CI = 1.26-1.43，P = 0.004）。剂量反应分析显示，TMAO浓度与MACE发生率呈“ J”型关联（P = 0.033），浓度高于5.1μmol/ L与HR> 1相关。结论结论TMAO升高与冠心病患者MACE发生率增加。TMAO浓度为5.1μmol/ L可能是预后的临界值。