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Abstract: TH-PO683

Relationship of Serum Trimethylamine N-Oxide and Betaine Levels with Risk of First Incident Stroke in Chinese Hypertensive Patients

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Nie, Jing, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • Xie, Liling, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • Li, Youbao, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • Zhu, Fengxin, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • Qin, Xianhui, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
Background

Trimethylamine N-oxide (TMAO), a gut derived metabolite, has been shown to be atherogenic. Whether TMAO or its dietary precursors is associated with a risk of stroke remains unknown. We aimed to determine the relationship of serum TMAO and its dietary precursors including choline, L-carnitine and betaine levels with first stroke in hypertensive patients, and examine any possible effect modifiers.

Methods

We conducted a nested case-control study, including 622 patients with first stroke (including 502 ischemic stroke, 118 hemorrhagic stroke and 2 uncertain type of stroke) and 622 matched controls from the China Stroke Primary Prevention Trial (CSPPT). The primary outcome was a first stroke.

Results

Overall, the risk of first stroke increased with each increment of TMAO level [per natural log (TMAO) increment: OR, 1.22; 95%CI: 1.02-1.46). Compared with participants in the lowest tertile (<1.79 μmol/L) of TMAO levels, a significantly higher risk of first stroke was found in those in higher TMAO tertiles (≥1.79 μmol/L) (OR, 1.34; 95% CI: 1.00-1.81) or in TMAO tertile 3 (≥3.19 μmol/L) (OR, 1.43; 95% CI: 1.02-2.01). However, a U-shaped association between serum betaine and the risk of first ischemic stroke was observed. The risk of first ischemic stroke decreased with the increment of betaine (per 10 μmol/L increase: OR, 0.87; 95%CI: 0.77-0.99) in patients with betaine <77.7 μmol/L, and increased with the betaine increment (per 10 μmol/L increase: OR, 1.17; 95%CI: 1.01-1.36) in participants with betaine ≥77.7 μmol/L. Serum betaine had no obvious effect on the risk of first hemorrhagic stroke (per 10 μmol/L increase: OR, 0.98; 95%CI: 0.82, 1.17). Moreover, no significant association between either choline (OR, 1.05; 95%CI: 0.68- 1.64) or L-carnitine (OR, 1.05; 95%CI: 0.60-1.85) with the risk of first stroke was found.

Conclusion

Among Chinese hypertensive patients, higher TMAO levels were associated with increased risk of first stroke while the association between betaine levels and the risk of first ischemic stroke was a U-shaped, with a turning point at about 77.7 μmol/L.