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Ethnic differences in associations of outcomes with trimethylamine N-oxide in acute heart failure patients

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posted on 30.06.2020, 09:58 by Yoshiyuki Yazaki, K Aizawa, K Negishi, Andrea Salzano, Y Saitoh, K Kono, Muhammed Zubair Israr, Liam HeaneyLiam Heaney, Y Imai, K Kario, R Nagai, Leong Ng, Toru Suzuki
Aims The aim of this study was to investigate whether ethnicity influences the associations between trimethylamine N-oxide (TMAO) levels and heart failure (HF) outcomes. Methods and results Trimethylamine N-oxide levels were measured in two cohorts with acute HF at two sites. The UK Leicester cohort consisted mainly of Caucasian (n = 842, 77%) and South Asian (n = 129, 12%) patients, whereas patients in the Japanese cohort (n = 116, 11%) were all Japanese. The primary endpoint was the measurement of all-cause mortality and/or HF rehospitalization within 1 year post-admission. Association of TMAO levels with outcome was compared in the entire population and between ethnic groups after adjustment for clinical parameters. TMAO levels were significantly higher in Japanese patients [median (interquartile range): 9.9 μM (5.2–22.8)] than in Caucasian [5.9 μM (3.6–10.8)] and South Asian [4.5 μM (3.1–8.4)] (P < 0.001) patients. There were no differences in the rate of mortality and/or HF rehospitalization between the ethnic groups (P = 0.096). Overall, higher TMAO levels showed associations with mortality and/or rehospitalization after adjustment for confounders ( P = 0.002). Despite no differences between ethnicity and association with mortality/HF after adjustment (P = 0.311), only in Caucasian patients were TMAO levels able to stratify for a mortality/HF event (P < 0.001). Conclusions Differences were observed in the association of mortality and/or rehospitalization based on circulating TMAO levels. Elevated TMAO levels in Caucasian patients showed increased association with adverse outcomes, but not in non-Caucasian patients.


Japan Agency for Medical Research and Development (AMED) (17ek0210011h0005)

Grants-in-Aid for Scientific Research in Priority Areas (B) (16H05115)



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ESC Heart Failure






2373 - 2378


John Wiley & Sons Ltd on behalf of the European Society of Cardiology


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This is an Open Access Article. It is published by Wiley under the Creative Commons Attribution-NonCommercial 4.0 International Licence (CC BY-NC). Full details of this licence are available at:

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Dr Liam Heaney Deposit date: 30 June 2020