Abstract
Plasma trimethylamine N-oxide (TMAO) is associated with coronary atherosclerotic plaque and cardiovascular disease risk, but associations between gut microbes in acute coronary syndrome (ACS) and post-ST-segment elevation myocardial infarction (post-STEMI) events are unknown. We investigated associations between gut microbial taxa and systemic TMAO levels and the possible TMAO contribution to incident post-STEMI cardiovascular events. Patients and Methods. A total of 60 patients, including 30 with unstable angina pectoris (UAP), 30 post-STEMI and 30 healthy controls, were enrolled from June to November 2017. Metagenomic sequencing was performed and TMAO and IL-6 were detected. Results. Minimal discriminators of gut microbial taxa (top 40) distinguished ACS patients from controls. Serum TMAO levels were positively associated with increased abundance of Aerococcaceae, Ruminococcaceae_UCG.005, Ruminococcaceae_UCC.014 and X. Eubacterium_fissicatena, and decreased abundance of Lachnospiraceae_FCS020 (P < 0.05). Elevated serum TMAO levels correlated independently with ACS (P < 0.05). Risk stratification for incident major adverse cardiovascular events (MACE) improved at one year in patients with serum TMAO levels ≦2.19 µM. Serum interleukin-6 levels were not significantly increased in patients with ACS and post-STEMI MACE. Conclusions. ACS and incident post-STEMI MACE may be associated with the gut bacteria choline metabolite TMAO. The specific gut microbial taxa identified in association with serum TMAO levels may be potential predictive biomarkers for accurate diagnosis of ACS onset.
Highlights
Myocardial infarction (MI) is a frequent cause of heart failure and cardiac death worldwide[1], accounting for about 18 million deaths annually, or about 30% of all deaths globally[2,3]
Compared to the control group, serum trimethylamine N-oxide (TMAO) levels were significantly increased in acute coronary syndrome (ACS) patients but no significant differences were found between segment elevation myocardial infarction (STEMI) and unstable angina pectoris (UAP) patients
Results of the present study revealed the presence and abundance of specific gut microbial taxa that may serve as potential predictive biomarkers for accurate diagnosis of ACS onset, including the increased abundance of Aerococcaceae, Ruminococcaceae_UCG.[005], Ruminococcaceae_UCC.[014] and X
Summary
Myocardial infarction (MI) is a frequent cause of heart failure and cardiac death worldwide[1], accounting for about 18 million deaths annually, or about 30% of all deaths globally[2,3]. The association between serum TMAO level and the extent of both the coronary atherosclerotic plaque burden and cardiovascular disease (CVD) risk has been demonstrated in multiple clinical studies[8,9,15,20,21]. Associations between serum TMAO level and the risk of incident cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) has not yet been examined. This association is relevant given that TMAO is shown in human and animal studies to link with altering stimulus-dependent calcium signalling, platelets, enhancing thrombosis potential, and fostering platelet hyperreactivity in vivo[12]. The purpose of this study was to explore associations between gut microbial taxa and systemic TMAO levels, and to investigate the contribution of the gut microbial metabolite TMAO to incident cardiovascular events after STEMI
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