Abstract:
:Peripheral artery disease (PAD) is a major cause of acute and chronic illness, with extremely poor prognosis that remains underdiagnosed and undertreated. Trimethylamine-N-Oxide (TMAO), a gut derived metabolite, has been associated with atherosclerotic burden. We determined plasma levels of TMAO by mass spectrometry and evaluated their association with PAD severity and prognosis. 262 symptomatic PAD patients (mean age 70 years, 87% men) categorized in intermittent claudication (IC, n = 147) and critical limb ischemia (CLI, n = 115) were followed-up for a mean average of 4 years (min 1-max 102 months). TMAO levels were increased in CLI compared to IC (P < 0.001). Receiver operating characteristic (ROC) curves for severity (CLI) rendered a cutoff of 2.26 µmol/L for TMAO (62% sensitivity, 76% specificity). Patients with TMAO > 2.26 µmol/L exhibited higher risk of cardiovascular death (sub-hazard ratios ≥2, P < 0.05) that remained significant after adjustment for confounding factors. TMAO levels were associated to disease severity and CV-mortality in our cohort, suggesting an improvement of PAD prognosis with the measurement of TMAO. Overall, our results indicate that the intestinal bacterial function, together with the activity of key hepatic enzymes for TMA oxidation (FMO3) and renal function, should be considered when designing therapeutic strategies to control gut-derived metabolites in vascular patients.
journal_name
Sci Repjournal_title
Scientific reportsauthors
Roncal C,Martínez-Aguilar E,Orbe J,Ravassa S,Fernandez-Montero A,Saenz-Pipaon G,Ugarte A,Estella-Hermoso de Mendoza A,Rodriguez JA,Fernández-Alonso S,Fernández-Alonso L,Oyarzabal J,Paramo JAdoi
10.1038/s41598-019-52082-zsubject
Has Abstractpub_date
2019-10-30 00:00:00pages
15580issue
1issn
2045-2322pii
10.1038/s41598-019-52082-zjournal_volume
9pub_type
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