Prognostic value of choline and betaine depends on intestinal microbiota-generated metabolite trimethylamine-N-oxide

AIMS: Recent metabolomics and animal model studies show trimethylamine-N-oxide (TMAO), an intestinal microbiota-dependent metabolite formed from dietary trimethylamine-containing nutrients such as phosphatidylcholine (PC), choline, and carnitine, is linked to coronary artery disease pathogenesis. Our aim was to examine the prognostic value of systemic choline and betaine levels in stable cardiac patients. METHODS AND RESULTS: We examined the relationship between fasting plasma choline and betaine levels and risk of major adverse cardiac events (MACE = death, myocardial infraction, stroke) in relation to TMAO over 3 years of follow-up in 3903 sequential stable subjects undergoing elective diagnostic coronary…

• OO
  Office of Dietary Supplements

  Awards: R01HL103866, P20HL113452
• AH
  American Heart Association

  Award: 12SDG12050473
• CC
  Cleveland Clinic
• NI
  National Institutes of Health

  Awards: P01HL076491, R01HL103866, P01HL098055, R01HL103931, P20HL113452
• NH
  National Heart, Lung, and Blood Institute

  Awards: P01HL076491, P01HL098055, R01HL103866, R01HL103931