Trimethyllysine predicts all-cause and cardiovascular mortality in community-dwelling adults and patients with coronary heart disease. Issue 1 (16th July 2021)

• Record Type: Journal Article
• Authors: Bjørnestad, Espen Ø; Dhar, Indu; Svingen, Gard F T; Pedersen, Eva R; Svenningsson, Mads M; Tell, Grethe S; Ueland, Per M; Ørn, Stein; Sulo, Gerhard; Laaksonen, Reijo; Nygård, Ottar
• Editors: Carrero, Juan-Jesus
• Is Part Of: European Heart Journal Open. Volume 1:Issue 1(2021)
• Publication Date: 2021-07-16
• Subjects: Epidemiology -- Risk factor -- Cardiovascular outcomes -- Mortality; 616
• DOI: 10.1093/ehjopen/oeab007
• Languages: English
• ISSNs: 2752-4191

Abstract

Abstract: Aims: Trimethyllysine (TML) is involved in carnitine synthesis, serves as a precursor of trimethylamine N -oxide (TMAO) and is associated with cardiovascular events in patients with established coronary heart disease (CHD). We prospectively examined circulating TML as a predictor of all-cause and cardiovascular mortality in community-dwelling adults and patients with CHD. Methods and results: By Cox regression modelling, risk associations were examined in 6393 subjects in the community-based Hordaland Health Study (HUSK). A replication study was conducted among 4117 patients with suspected stable angina pectoris in the Western Norway Coronary Angiography Cohort (WECAC). During a mean follow-up of 10.5 years in the HUSK-cohort, 884 (13.8%) subjects died, of whom 287 from cardiovascular causes. After multivariable adjustments for traditional cardiovascular risk factors, the hazard ratio (HR) [95% confidence interval (95% CI)] for all-cause mortality comparing the 4th vs. 1st TML-quartile was 1.66 (1.31–2.10, P < 0.001). Particularly strong associations were observed for cardiovascular mortality [HR (95% CI) 2.04 (1.32–3.15, P = 0.001)]. Corresponding risk-estimates in the WECAC (mean follow-up of 9.8 years) were 1.35 [1.10–1.66, P = 0.004] for all-cause and 1.45 [1.06–1.98, P = 0.02] for cardiovascular mortality. Significant correlations between plasma TML and TMAO were observed in both cohorts ( rs ≥ 0.42, P < 0.001); however, additional adjustments for TMAO did not materially influence the risk associations, and no effect modification by TMAO was found. Conclusions: Elevated TML-levels were associated with increased risk of all-cause and cardiovascular mortality both in subjects with and without established CHD. Graphical Abstract: