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https://doi.org/10.1371/journal.pone.0114969
Title: | Betaine and trimethylamine-N-oxide as predictors of cardiovascular outcomes show different patterns in diabetes mellitus: An observational study | Authors: | Lever M. George P.M. Slow S. Bellamy D. Young J.M. Ho M. McEntyre C.J. Elmslie J.L. Atkinson W. Molyneux S.L. Troughton R.W. Frampton C.M. Richards A.M. Chambers S.T. |
Keywords: | betaine trimethylamine oxide betaine biological marker methylamine trimethyloxamine acute coronary syndrome acute heart infarction adult aged amino acid blood level Article cardiovascular disease cohort analysis controlled study female glomerulus filtration rate heart failure human male non insulin dependent diabetes mellitus observational study outcome assessment predictor variable risk factor unstable angina pectoris blood cardiovascular disease case control study complication Kaplan Meier method middle aged non insulin dependent diabetes mellitus proportional hazards model very elderly Acute Coronary Syndrome Aged Aged, 80 and over Betaine Biomarkers Cardiovascular Diseases Case-Control Studies Diabetes Mellitus, Type 2 Female Humans Kaplan-Meier Estimate Male Methylamines Middle Aged Proportional Hazards Models Risk Factors |
Issue Date: | 2014 | Citation: | Lever M., George P.M., Slow S., Bellamy D., Young J.M., Ho M., McEntyre C.J., Elmslie J.L., Atkinson W., Molyneux S.L., Troughton R.W., Frampton C.M., Richards A.M., Chambers S.T. (2014). Betaine and trimethylamine-N-oxide as predictors of cardiovascular outcomes show different patterns in diabetes mellitus: An observational study. PLoS ONE 9 (12) : e114969. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0114969 | Rights: | Attribution 4.0 International | Abstract: | Background: 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?Methods: Plasma samples were collected from 475 subjects four months after discharge following an acute coronary admission. Death (n581), secondary acute MI (n587), admission for heart failure (n585), unstable angina (n572) and all cardiovascular events (n5283) were recorded (median follow-up: 1804 days).Results: High and low metabolite concentrations were defined as top or bottom quintile of the total cohort. In subjects with diabetes (n579), 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 (n5396), 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.Conclusions: 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. | Source Title: | PLoS ONE | URI: | https://scholarbank.nus.edu.sg/handle/10635/161756 | ISSN: | 19326203 | DOI: | 10.1371/journal.pone.0114969 | Rights: | Attribution 4.0 International |
Appears in Collections: | Elements Staff Publications |
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