Current Nutrition Reports

, Volume 7, Issue 4, pp 207–213 | Cite as

Trimethylamine N-Oxide and Risk of Cardiovascular Disease and Mortality

  • Chanavuth Kanitsoraphan
  • Pattara Rattanawong
  • Suranut Charoensri
  • Vichai Senthong
Cardiovascular Disease (JHY Wu, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardiovascular Disease


Purpose of Review

Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite produced from choline and phosphatidylcholine. Trimethylamine N-oxide was found associated with enhanced atherosclerosis and thrombosis in vitro and in vivo. We summarized available clinical studies which investigated TMAO’s role in predicting prognostic outcomes, including mortality, in patients with cardiovascular diseases.

Recent Findings

In chronic kidney disease cohorts, higher TMAO levels were significantly associated with higher mortality from 1.18 to 4.32 folds. Higher TMAO levels were not significantly associated with mortality in patient undergoing dialysis. In patients with peripheral artery disease, higher TMAO levels were associated with higher overall mortality from 1.38 to 2.06 folds. In patients with type 2 diabetes, higher TMAO levels were significantly associated with higher overall mortality 2.07 to 2.7 folds. In patients with heart failure, higher TMAO levels were associated with higher mortality or cardiac transplantation 1.18 to 1.79 folds.


TMAO levels could potentially be integrated to existed risk stratification tools and could lead to novel prevention and treatment approaches to cardiovascular disease. Nonetheless, more studies would be needed to clarify predictive value of TMAO to specific groups of patients. Mechanisms how TMAO affect atherosclerosis and confounding effects of TMAO with traditional cardiovascular parameters should also be further investigated.


Trimethylamine N-oxide Cardiovascular disease 


Authors’ Contribution

Chanavuth Kanitsoraphan: Draft manuscript.

Pattara Rattanawong: Draft manuscript.

Suranut Charoensri MD: Draft Manuscript.

Vichai Senthong: Conception design, final approval, corresponding author.

Compliance with Ethical Standards

Conflict of Interest

Chanavuth Kanitsoraphan, Pattara Rattanawong, Suranut Charoensri, and Vichai Senthong declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Chanavuth Kanitsoraphan
    • 1
  • Pattara Rattanawong
    • 1
  • Suranut Charoensri
    • 2
  • Vichai Senthong
    • 3
  1. 1.University of Hawaii Internal Medicine Residency ProgramHonoluluUSA
  2. 2.Division of Endocrinology and Metabolism, Department of Medicine, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
  3. 3.Cardiovascular Unit, Department of Medicine, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand

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