Sex-specific differences in trimethylamine N-oxide (TMAO) concentrations before and after cardiac rehabilitation in acute myocardial infarction patients

Abstract

Trimethylamine N-oxide (TMAO) is a biomarker of cardiovascular risk and may enhance the progression of atherosclerosis. The aim of the study was to determine whether there are sex-specific differences in TMAO concentrations before and after cardiac rehabilitation in acute myocardial infarction (AMI) patients. A total of 56 participants [45/56 (80.4 %) males, 11/56 (19.6 %) females] were drawn from AMI inpatients hospitalized at the Division of Cardiology, Medical University of Graz, Austria. For the assessment of TMAO, serum samples were collected within the first day after hospital admission due to AMI and at the start and end of cardiac rehabilitation. Shortly after hospital admission due to AMI, females had significantly higher TMAO blood concentrations than males. These initially high TMAO levels remained almost unchanged in the female AMI patients until the start of cardiac rehabilitation and only reached the lower TMAO concentrations observed in the male patients after rehabilitation [female patients: TMAO (acute myocardial infarction) = 5.93 μmol/L (SE = 1.835); TMAO (start of rehabilitation) = 5.68 μmol/L (SE = 1.217); TMAO (end of rehabilitation) = 3.89 μmol/L (SE = 0.554); male patients: TMAO (acute myocardial infarction) = 3.02 μmol/L (SE = 0.255), TMAO (start of rehabilitation) = 3.91 μmol/L (SE = 0.346), TMAO (end of rehabilitation) = 4.04 μmol/L (SE = 0.363)]. After AMI, women might be at higher cardiovascular risk due to persistently higher levels of TMAO. High TMAO levels in women might decrease after cardiac rehabilitation due to cardiac rehabilitation-associated lifestyle modifications. These lifestyle modifications after AMI might also prevent increases in TMAO concentrations in men.

Sex differences in the physiological responses to cardiac rehabilitation: a systematic review

“… 12 ANOVA Araya-Ramirez 2021 [ 64 ] Cardiac patients enrolled in a university-based CR program n = 311 (237 men, 74 women) Aerobic 12 Weeks 92% adherence for men and women 12 ANCOVA Balady 1996 [ 54 ] Patients experiencing MI, CABG, or PTCA within 6 months of program n = 778 (558 men, 220 women) Aerobic with Strength at some centers. 10 ± 2 weeks CR completion: 33% 182/558 men, 28% 61/220 women; 83% adherence rate for men and women 12 t-test Baranyi 2022 [ 103 ] Patients with acute MI n = 56 (45 men, 11 women) Not described 4 weeks CR completion: 100% 10 ANCOVA Bellet 2015 [ 65 ] Patients with a diagnosis of MI, angina, controlled arrhythmia, CAD or PCI, CABG, or experienced cardiac valve surgery, defibrillator, or pacemaker implantation. Patients were divided into a fast-track CR or a traditional CR program n = 197 (130 men, 67 women) Fast Track CR, n = 423 (332 men, 91 women) Traditional CR Aerobic and Strength 6 Weeks CR completion: 58% 115/197 fast track CR patients and 60% 254/423 traditional CR patients.…”

Effect of dapagliflozin on ferroptosis through the gut microbiota metabolite TMAO during myocardial ischemia–reperfusion injury in diabetes mellitus rats

“…TMAO is a gut microbiota-dependent metabolite produced from choline and phosphatidylcholine 10 . Elevated concentrations of TMAO in both the plasma and cerebrospinal fluid have been demonstrated to play a significant role in the emergence of risk factors and actively facilitate the pathogenesis of metabolic, cardiovascular, and cerebrovascular disorders 37 – 39 . When there is an imbalance in gut microbiota and a decrease in probiotics, the ingestion of choline in the diet can lead to the metabolic conversion of choline by intestinal bacteria, resulting in the production of trimethylamine.…”