Abstract
Atherosclerosis is associated with various pathological manifestations, such as ischemic heart disease, ischemic stroke, and peripheral arterial disease, and remains a leading cause of public health concern. Atherosclerosis is an inflammatory disease characterized by endothelial dysfunction; vascular inflammation; and the deposition of lipids, cholesterol, calcium, and cellular debris within the vessel wall intima. In-depth studies of gut flora in recent years have shown that bacterial translocation and the existence of bacterial active products in blood circulation can affect the inflammatory state of the whole blood vessel. The gut flora is considered to be a large “secretory organ,” which produces trimethylamine-N-oxide (TMAO), short-chain fatty acids and secondary bile acids by breaking down the ingested food. Studies have shown that TMAO is an independent risk factor for the occurrence of malignant adverse cardiovascular events, but whether it is harmful or beneficial to patients with cardiovascular diseases with mild or no clinical manifestations remains controversial. We review the relationship between TMAO and its precursor (L-carnitine) and coronary atherosclerosis and summarize the potential molecular mechanism and therapeutic measures of TMAO on coronary atherosclerosis.
Highlights
Atherosclerosis (AS) is a disease of large- and medium-sized arteries and is characterized by endothelial dysfunction, vascular inflammation, and the buildup of lipids, cholesterol, calcium, and cellular debris within the vessel wall intima
We describe in detail how TMAO promotes the transformation of macrophages to foam cells, which lead to reverse cholesterol transport that inhibits bile acid and sterol metabolism, and at the same time enhances the hyperactivity of platelets, which leads to the formation of atherosclerotic plaques
A recent prospective case-control study [17] showed that in a 10-year period, regardless of the level of baseline TMAO, the final increase in TMAO was significantly associated with an increased risk of coronary atherosclerotic heart disease (CHD), and the TMAO– CHD relationship could be improved by dietary changes [17]
Summary
Atherosclerosis (AS) is a disease of large- and medium-sized arteries and is characterized by endothelial dysfunction, vascular inflammation, and the buildup of lipids, cholesterol, calcium, and cellular debris within the vessel wall intima. Extensive research on intestinal flora in recent years has shown that bacterial translocation and the existence of bacterial active products in the blood circulation can aggravate the inflammatory state of the whole blood vessel These changes in the composition of the intestinal microbiota have been associated with diseases such as atherosclerosis, hypertension, heart failure, chronic kidney disease, obesity, and type 2 diabetes [2]. TMAO and Chronic Coronary Artery Disease In recent years, several studies have suggested that TMAO is a new independent risk factor for atherosclerosis (Table 1). Substantial evidence suggests that an increase in the level of TMAO is associated with the risk of cardiovascular diseases including atherosclerosis, chronic kidney disease, and hypertension, the direct effect of TMAO on vascular endothelial function remains unclear. But not acute, phase TMAO level is a significant and independent
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