From:  Comparison of short-term and long-term effects of peroral L-carnitine intake: clinical implications of elevated TMAO levels in cardiovascular complications
 

Adverse cardiac events associated with increased TMAO levels

Cardiac eventDescriptionMechanism
MI

  • The blood supply to the heart is blocked

  • Often due to atherosclerotic plaque

  • Elevated plasma TMAO may increase the risk of MI particularly in individuals with impaired vascular repair

  • Prolonged high TMAO levels are linked with atherosclerosis

  • TMAO may serve as a biomarker for predicting prognosis in MI patients

Stroke

  • Cerebrovascular event caused by disruption of blood flow to the brain

  • Elevated TMAO levels are associated with hypertension, an important risk factor for ischemic stroke

  • It may worsen vascular dysfunction and inflammation leading to cerebral embolism

AF

  • A common yet serious arrhythmia characterized by rapid and irregular heartbeats

  • Increased TMAO levels are associated with increased electrical remodeling and inflammation

  • These are some of the crucial factors leading to arrhythmias like AF

  • It enhances the autonomic remodeling and activities the p65 NF-κB signaling pathway, increasing atrial instability

HF

  • Condition in which the heart is unable to pump the blood effectively

  • Elevated TMAO levels may contribute to HF through mechanisms involving oxidative stress and inflammation

  • Associated with metabolic syndrome

SCD

  • Unexpected death due to cardia caused, often associated with HF and arrhythmia

  • Elevated TMAO and L-carnitine intake are linked to SCD through their contributions to arrhythmias and atherosclerosis

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HF: heart failure; TMAO: trimethylamine-N-oxide; MI: myocardial infarction; AF: atrial fibrillation; SCD: sudden cardiac death; NF-κB: nuclear factor kappa-light-chain-enhancer of activated B cells