The Association of Plasma Trimethylamine N-Oxide with Coronary Atherosclerotic Burden in Patients with Type 2 Diabetes Among a Chinese North Population

Na Yu,1 Nan Gu,1 Yuxin Wang,1 Bin Zhou,2 Difei Lu,1 Jianping Li,3 Xiaowei Ma,1 Junqing Zhang,1 Xiaohui Guo1 1Department of Endocrinology, Peking University First Hospital, Beijing, 100034, People’s Republic of China; 2Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China; 3Department of Cardiology, Peking University First Hospital, Beijing, 100034, People’s Republic of ChinaCorrespondence: Xiaowei MaDepartment of Endocrinology, Peking University First Hospital, Beijing, People’s Republic of ChinaTel/Fax +86-010-83572574Email xiaowei.ma@pkufh.comPurpose: We aimed to examine the association between plasma trimethylamine N-oxide (TMAO), a gut microbial metabolite from dietary phosphatidylcholine, and coronary atherosclerotic burden in patients with type 2 diabetes (T2D).Methods: In total, 349 patients with T2D were studied, including 70 controls and 279 patients with coronary artery disease (CAD) by coronary angiography. Coronary atherosclerotic burden is quantified by the number of diseased coronary branches and SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score. Plasma TMAO levels were determined by UHPLC–MS/MS technique.Results: The TMAO concentration was significantly higher in the patients with triple vessel disease (TVD) (3.33 [IQR: 1.81– 6.65] μM) than those without TVD (2.62 [IQR: 1.50– 4.73] μM) (P = 0.015). A similar difference was found between patients with SYNTAX score > 22 (3.93 [IQR: 1.81– 6.82] μM) and those with SYNTAX score ≤ 22 (2.54 [IQR: 1.44– 4.54] μM) (P = 0.014). TMAO was not significantly correlated with the presence of CAD. Among patients with eGFR < 60 mL/min/1.73 m2, the highest tertile of TMAO was significantly associated with TVD (OR = 25.28