Betaine and Trimethylamine-N-Oxide as Predictors of Cardiovascular Outcomes Show Different Patterns in Diabetes Mellitus: An Observational Study.
Betaine and Trimethylamine-N-Oxide as Predictors of Cardiovascular Outcomes Show Different Patterns in Diabetes Mellitus: An Observational Study.
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DOI：
10.1371/journal.pone.0114969
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Chambers ST
中科院分区：
文献类型：
--
作者：
Lever M;George PM;Slow S;Bellamy D;Young JM;Ho M;McEntyre CJ;Elmslie JL;Atkinson W;Molyneux SL;Troughton RW;Frampton CM;Richards AM;Chambers ST
甜菜碱是一种主要的渗透物，在甲基代谢中也很重要。血液中甜菜碱、其代谢物二甲基甘氨酸和类似物三甲胺- n -氧化物（TMAO）的浓度是心血管疾病的危险标志。糖尿病扰乱甜菜碱：糖尿病是否改变了甜菜碱相关指标与心血管风险之间的关系？475名受试者在急性冠状动脉入院后出院4个月后收集血浆样本。死亡（n = 81）、继发性急性心肌梗死（n = 87）、因心力衰竭入院（n = 85）、不稳定型心绞痛（n = 72）和所有心血管事件（n = 283）被记录下来（中位随访：1804天）。高代谢物浓度和低代谢物浓度被定义为总队列的最高或最低五分之一。在糖尿病患者中（n = 79），高血浆甜菜碱与事件频率增加有关；心力衰竭的风险比为3.1(1.2-8.2)，所有心血管事件的风险比为2.8（1.4-5.5）。在没有糖尿病的受试者中（n = 396），低血浆甜菜碱与事件相关；继发性心肌梗死的HR为2.1(1.2-3.6)，不稳定型心绞痛的HR为2.3(1.3-4.0)，所有心血管事件的HR为1.4（1.0-1.9）。在糖尿病中，高TMAO是所有结局的标志，死亡的HR为2.7(1.1-7.1)，心肌梗死的HR为4.0(1.6-9.8)，心力衰竭的HR为4.6(2.0 - 10.7)，不稳定心绞痛的HR为9.1(2.8-29.7)，所有心血管事件的HR为2.0（1.1-3.6）。在没有糖尿病的受试者中，TMAO仅与死亡（HR 2.7(1.6-4.8)）和心力衰竭（HR 1.9(1.1-3.4)）相关。在Cox回归模型中加入估计的肾小球滤过率倾向于增加与低甜菜碱相关的表观风险。血浆中甜菜碱浓度升高是糖尿病患者心血管风险的标志；相反，低血浆甜菜碱浓度表明在没有糖尿病的情况下风险增加。我们推测，这种差异反映了组织中渗透液潴留的控制。血浆TMAO升高是糖尿病的一个重要危险标志。
Betaine is a major osmolyte, also important in methyl group metabolism. Concentrations of betaine, its metabolite dimethylglycine and analog trimethylamine-N-oxide (TMAO) in blood are cardiovascular risk markers. Diabetes disturbs betaine: does diabetes alter associations between betaine-related measures and cardiovascular risk? Plasma samples were collected from 475 subjects four months after discharge following an acute coronary admission. Death (n = 81), secondary acute MI (n = 87), admission for heart failure (n = 85), unstable angina (n = 72) and all cardiovascular events (n = 283) were recorded (median follow-up: 1804 days). High and low metabolite concentrations were defined as top or bottom quintile of the total cohort. In subjects with diabetes (n = 79), high plasma betaine was associated with increased frequencies of events; significantly for heart failure, hazard ratio 3.1 (1.2–8.2) and all cardiovascular events, HR 2.8 (1.4–5.5). In subjects without diabetes (n = 396), low plasma betaine was associated with events; significantly for secondary myocardial infarction, HR 2.1 (1.2–3.6), unstable angina, HR 2.3 (1.3–4.0), and all cardiovascular events, HR 1.4 (1.0–1.9). In diabetes, high TMAO was a marker of all outcomes, HR 2.7 (1.1–7.1) for death, 4.0 (1.6–9.8) for myocardial infarction, 4.6 (2.0–10.7) for heart failure, 9.1 (2.8–29.7) for unstable angina and 2.0 (1.1–3.6) for all cardiovascular events. In subjects without diabetes TMAO was only significant for death, HR 2.7 (1.6–4.8) and heart failure, HR 1.9 (1.1–3.4). Adding the estimated glomerular filtration rate to Cox regression models tended to increase the apparent risks associated with low betaine. Elevated plasma betaine concentration is a marker of cardiovascular risk in diabetes; conversely low plasma betaine concentrations indicate increased risk in the absence of diabetes. We speculate that the difference reflects control of osmolyte retention in tissues. Elevated plasma TMAO is a strong risk marker in diabetes.
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影响因子：
3.7
作者：
Lever M;George PM;Elmslie JL;Atkinson W;Slow S;Molyneux SL;Troughton RW;Richards AM;Frampton CM;Chambers ST
通讯作者：
Chambers ST
影响因子：
2.8
作者：
Lever, Michael;Atkinson, Wendy;George, Peter M.
通讯作者：
George, Peter M.
影响因子：
5
作者：
LEVER, M;SIZELAND, PCB;CHAMBERS, ST
通讯作者：
CHAMBERS, ST
影响因子：
3.7
作者：
Lever M;George PM;Atkinson W;Molyneux SL;Elmslie JL;Slow S;Richards AM;Chambers ST
通讯作者：
Chambers ST
影响因子：
158.5
作者：
Cannon, CP;Weintraub, WS;Braunwald, E
通讯作者：
Braunwald, E