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Open AccessVollständige AnalyseJun 16, 2026

Association Between Plasma TMAO Levels and Subclinical Atherosclerosis in Asymptomatic Adults

This cross-sectional observational study found a positive association between elevated plasma TMAO and greater carotid intima-media thickness (CIMT) in asymptomatic adults, but the design precludes causal inference.

The question (PICO)
PopulationAsymptomatic adults aged 25–60 years without established cardiovascular disease, recruited from outpatient clinics at a tertiary care hospital
InterventionPlasma TMAO measurement
VergleichInternal comparison across TMAO strata (tertiles or quartiles); no external randomized control group
EndpunktCIMT (mm) by carotid ultrasound as a marker of subclinical atherosclerosis; secondary: association of TMAO with traditional cardiovascular risk factors (BMI, smoking, hypertension, diabetes, dyslipidemia)
CEvidenz
Studie
Observational study
Effekt
Günstig
Dauer
6 Monate
Zusammenfassung der Ergebnisse nach Endpunkt
EndpunktGradRichtungEffektStudien
Carotid intima-media thickness (CIMT)C Günstigdados numéricos não disponíveis no texto fornecido1
TMAO association with BMI/obesityC Unzureichenddados numéricos não disponíveis no texto fornecido1
TMAO association with hypertensionC Unzureichenddados numéricos não disponíveis no texto fornecido1
TMAO association with dyslipidemiaC Unzureichenddados numéricos não disponíveis no texto fornecido1
TMAO association with diabetes mellitusC Unzureichenddados numéricos não disponíveis no texto fornecido1
TMAO association with smokingC Unzureichenddados numéricos não disponíveis no texto fornecido1
Carotid plaque (presence/absence)C Unzureichenddados numéricos não disponíveis no texto fornecido1
Carotid intima-media thickness (CIMT)C
Richtung Günstig
Effektdados numéricos não disponíveis no texto fornecido
Studien1
TMAO association with BMI/obesityC
Richtung Unzureichend
Effektdados numéricos não disponíveis no texto fornecido
Studien1
TMAO association with hypertensionC
Richtung Unzureichend
Effektdados numéricos não disponíveis no texto fornecido
Studien1
TMAO association with dyslipidemiaC
Richtung Unzureichend
Effektdados numéricos não disponíveis no texto fornecido
Studien1
TMAO association with diabetes mellitusC
Richtung Unzureichend
Effektdados numéricos não disponíveis no texto fornecido
Studien1
TMAO association with smokingC
Richtung Unzureichend
Effektdados numéricos não disponíveis no texto fornecido
Studien1
Carotid plaque (presence/absence)C
Richtung Unzureichend
Effektdados numéricos não disponíveis no texto fornecido
Studien1

Kontext

TMAO is a gut microbiota-derived metabolite linked to adverse cardiovascular outcomes in populations with established disease. Its role in subclinical atherosclerosis among healthy individuals remains poorly characterized. Identifying early biomarkers could improve preclinical cardiovascular risk stratification.

Was die Studie zeigte

The provided text does not report complete numerical results — absolute CIMT values by group, effect sizes, 95% CIs, and p-values are absent from the available excerpt. The narrative indicates a positive association between TMAO and CIMT, but concrete figures are not available. No absolute case counts of elevated CIMT per TMAO stratum were reported. The absence of quantitative data prevents effect magnitude assessment.

Wie es durchgeführt wurde

Single-center cross-sectional observational study conducted at a tertiary hospital from March to September 2025 in general medicine and cardiology outpatient departments. Participants were recruited during routine health check-ups or visits for minor non-cardiovascular conditions. Exact sample size and detailed exclusion criteria are not provided in the available excerpt.

Effektgröße

Effect size data (RR, OR, SMD, MD with 95% CI) are not present in the provided study excerpt; effect magnitude cannot be quantified from available data.

Einschränkungen

Cross-sectional design prevents establishing temporality or causality between TMAO and CIMT. Single tertiary hospital recruitment limits population representativeness. Dietary confounders (choline, carnitine, fish intake) were not adequately controlled per the available excerpt. Lack of longitudinal adjustment and microbiome compositional data are additional relevant limitations. Risk of bias assessment tool (ROBINS-I, appropriate for observational studies) was not mentioned by the authors.

In der klinischen Praxis

This study does NOT support routine clinical use of plasma TMAO as a screening biomarker for subclinical atherosclerosis. CIMT remains the validated marker of choice for subclinical risk stratification. Clinicians should not modify practice based on this single study.

Was noch fehlt

Prospective cohort studies with longitudinal follow-up, dietary control, and microbiome composition assessment are needed to determine whether TMAO predicts CIMT progression or cardiovascular events in asymptomatic populations.

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