Microbiota-Dependent Metabolite Trimethylamine N-Oxide and Coronary Artery Calcium in the Coronary Artery Risk Development in Young Adults Study (CARDIA)

J Am Heart Assoc. 2016 Oct 21;5(10):e003970. doi: 10.1161/JAHA.116.003970.


Background: Clinical studies implicate trimethylamine N-oxide (TMAO; a gut microbiota-dependent nutrient metabolite) in cardiovascular disease risk. There is a lack of population-based data on the role of TMAO in advancing early atherosclerotic disease. We tested the prospective associations between TMAO and coronary artery calcium (CAC) and carotid intima-media thickness (cIMT).

Methods and results: Data were from the Coronary Artery Risk Development in Young Adults Study (CARDIA), a biracial cohort of US adults recruited in 1985-1986 (n=5115). We randomly sampled 817 participants (aged 33-55 years) who attended examinations in 2000-2001, 2005-2006, and 2010-2011, at which CAC was measured by computed tomography and cIMT (2005-2006) by ultrasound. TMAO was quantified using liquid chromotography mass spectrometry on plasma collected in 2000-2001. Outcomes were incident CAC, defined as Agatston units=0 in 2000-2001 and >0 over 10-year follow-up, CAC progression (any increase over 10-year follow-up), and continuous cIMT. Over the study period, 25% (n=184) of those free of CAC in 2000-2001 (n=746) developed detectable CAC. In 2000-2001, median (interquartile range) TMAO was 2.6 (1.8-4.2) μmol/L. In multivariable-adjusted models, TMAO was not associated with 10-year CAC incidence (rate ratio=1.03; 95% CI: 0.71-1.52) or CAC progression (0.97; 0.68-1.38) in Poisson regression, or cIMT (beta coefficient: -0.009; -0.03 to 0.01) in linear regression, comparing the fourth to the first quartiles of TMAO.

Conclusions: In this population-based study, TMAO was not associated with measures of atherosclerosis: CAC incidence, CAC progression, or cIMT. These data indicate that TMAO may not contribute significantly to advancing early atherosclerotic disease risk among healthy early-middle-aged adults.

Keywords: atherosclerosis; biomarker; epidemiology; follow‐up study; risk factor.

MeSH terms

  • Adult
  • Atherosclerosis / blood*
  • Atherosclerosis / diagnostic imaging
  • Atherosclerosis / epidemiology
  • Black or African American
  • Carotid Intima-Media Thickness
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology
  • Disease Progression
  • Female
  • Gastrointestinal Microbiome*
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Methylamines / blood*
  • Middle Aged
  • Prospective Studies
  • Tomography, X-Ray Computed
  • United States / epidemiology
  • Vascular Calcification / blood*
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / epidemiology
  • White People


  • Methylamines
  • trimethyloxamine