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.
| Outcome | Grade | Direction | Effect | Studies |
|---|---|---|---|---|
| Carotid intima-media thickness (CIMT) | C | ▲ Favorable | dados numéricos não disponíveis no texto fornecido | 1 |
| TMAO association with BMI/obesity | C | — Insufficient | dados numéricos não disponíveis no texto fornecido | 1 |
| TMAO association with hypertension | C | — Insufficient | dados numéricos não disponíveis no texto fornecido | 1 |
| TMAO association with dyslipidemia | C | — Insufficient | dados numéricos não disponíveis no texto fornecido | 1 |
| TMAO association with diabetes mellitus | C | — Insufficient | dados numéricos não disponíveis no texto fornecido | 1 |
| TMAO association with smoking | C | — Insufficient | dados numéricos não disponíveis no texto fornecido | 1 |
| Carotid plaque (presence/absence) | C | — Insufficient | dados numéricos não disponíveis no texto fornecido | 1 |
Context
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.
What the study showed
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.
How it was done
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.
Effect magnitude
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.
Limitations
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 clinical practice
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.
What is still missing
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.