A microbial byproduct of intestinal bacteria contributes to heart disease and serves as an accurate screening tool for predicting future risks of heart attack, stroke and death in persons not otherwise identified by traditional risk factors and blood tests, according to Cleveland Clinic research published today in The New England Journal of Medicine.
The research team was led by Stanley Hazen, M.D., Ph.D., Vice Chair of Translational Research, Chair of the Department of Cellular and Molecular Medicine for the Lerner Research Institute and section head of Preventive Cardiology & Rehabilitation in the Miller Family Heart and Vascular Institute at Cleveland Clinic, and W.H. Wilson Tang, M.D., Department of Cardiovascular Medicine in the Miller Family Heart and Vascular Institute and Lerner Research Institute.
The current study is an extension of Dr. Hazen's previous work, in which he found that a chemical byproduct called trimethylamine N-oxide (TMAO) is produced when intestinal bacteria digest the nutrient phosphatidylcholine, commonly known as lecithin. The prior research showed that TMAO levels in the blood were associated with heart disease. Dr. Hazen and colleagues have now confirmed that gut flora are essential in forming TMAO in humans and demonstrated a relationship between TMAO levels and future cardiac events like heart attack, stroke, and death—even in those with no prior evidence of cardiac disease risk.
To demonstrate the role of gut flora in forming TMAO, human subjects were asked to eat two hard-boiled eggs (a common dietary source of lecithin) and a capsule of labeled lecithin (as a tracer). After ingestion, TMAO levels in the blood increased. However, when these same subjects were given a brief course of broad-spectrum antibiotics to suppress their gut flora, their TMAO levels were suppressed, and no additional TMAO was formed, even after ingesting lecithin. These results demonstrated that the intestinal bacteria are essential for the formation of TMAO.
In the second phase of the study, the researchers measured TMAO levels in a large, independent, clinical cohort – consisting of more than 4,000 adults undergoing cardiac evaluation at Cleveland Clinic – over a three-year follow-up period. They found that higher TMAO blood levels were associated with higher future risks of death and nonfatal heart attack or stroke over the ensuing three-year period, independent of other risk factors and blood test results. These results complement those of another recent study of Dr. Hazen's linking gut flora metabolism of a structurally similar nutrient found in animal products, carnitine, to TMAO production and heart attack risk.
"Heart disease remains the No. 1 killer, and while we know how to reduce cholesterol, treat blood pressure, and reduce cardiac risks through diet and other interventions, a substantial residual risk still remains," Dr. Hazen said. "We need to find new pathways to attack heart disease, and these findings strongly suggest that further research into the involvement of gut microbiome in the development of cardiovascular disease could lead to new avenues of prevention and treatment of heart disease."
About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. More than 3,000 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. The Cleveland Clinic health system includes a main campus near downtown Cleveland, more than 75 Northern Ohio outpatient locations, including 16 full-service Family Health Centers, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and, currently under construction, Cleveland Clinic Abu Dhabi. In 2012, there were 5.1 million outpatient visits throughout the Cleveland Clinic health system and 157,000 hospital admissions. Patients came for treatment from every state and from more than 130 countries. Visit us at http://www.clevelandclinic.org. Follow us at http://www.twitter.com/ClevelandClinic.
About the Lerner Research Institute
The Lerner Research Institute (LRI) is home to laboratory, translational and clinical research at Cleveland Clinic. Its three-part mission is: to promote human health by investigating the causes of disease and discovering new approaches to prevention and treatments, to train the next generation of biomedical researchers and to foster collaborations with clinical care providers. LRI's total annual research expenditure was $255 million in 2012 (nearly $110 million in federal funding). With more than 700,000 square feet of lab, office, and core services space, LRI is home to more than 2,000 people working in disease-focused research programs. In 2012, LRI researchers published over 600 articles in high-impact biomedical journals (top 10 percent) and generated 83 invention disclosures, 10 new licenses and 35 patents. LRI faculty oversee curriculum and teach courses in the Cleveland Clinic Lerner College of Medicine (CCLCM) of Case Western Reserve University and participate in doctoral programs, including the Molecular Medicine PhD Program, supported in part by the Howard Hughes Medical Institute.
Editor's Note: Cleveland Clinic News Service is available to provide broadcast-quality interviews and B-roll upon request.
Laura AmbroWyatt DuBois
Laura Ambro | EurekAlert!
ECG procedure indicates whether an implantable defibrillator will extend a patient's life
02.09.2019 | Technische Universität München
Fracking prompts global spike in atmospheric methane
14.08.2019 | European Geosciences Union
Researchers from the Department of Atomically Resolved Dynamics of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg, the University of Potsdam (both in Germany) and the University of Toronto (Canada) have pieced together a detailed time-lapse movie revealing all the major steps during the catalytic cycle of an enzyme. Surprisingly, the communication between the protein units is accomplished via a water-network akin to a string telephone. This communication is aligned with a ‘breathing’ motion, that is the expansion and contraction of the protein.
This time-lapse sequence of structures reveals dynamic motions as a fundamental element in the molecular foundations of biology.
Two research teams have succeeded simultaneously in measuring the long-sought Thorium nuclear transition, which enables extremely precise nuclear clocks. TU Wien (Vienna) is part of both teams.
If you want to build the most accurate clock in the world, you need something that "ticks" very fast and extremely precise. In an atomic clock, electrons are...
Researchers from Chalmers University of Technology have demonstrated a detector made from graphene that could revolutionize the sensors used in next-generation space telescopes. The findings were recently published in the scientific journal Nature Astronomy.
Beyond superconductors, there are few materials that can fulfill the requirements needed for making ultra-sensitive and fast terahertz (THz) detectors for...
A supersolid is a state of matter that can be described in simplified terms as being solid and liquid at the same time. In recent years, extensive efforts have been devoted to the detection of this exotic quantum matter. A research team led by Tilman Pfau and Tim Langen at the 5th Institute of Physics of the University of Stuttgart has succeeded in proving experimentally that the long-sought supersolid state of matter exists. The researchers report their results in Nature magazine.
In our everyday lives, we are familiar with matter existing in three different states: solid, liquid, or gas. However, if matter is cooled down to extremely...
A team headed by Prof. Steve Albrecht from the HZB will present a new world-record tandem solar cell at EU PVSEC, the world's largest international photovoltaic and solar energy conference and exhibition, in Marseille, France on September 11, 2019. This tandem solar cell combines the semiconducting materials perovskite and CIGS and achieves a certified efficiency of 23.26 per cent. One reason for this success lies in the cell’s intermediate layer of organic molecules: they self-organise to cover even rough semiconductor surfaces. Two patents have been filed for these layers.
Perovskite-based solar cells have experienced an incredibly rapid increase in efficiency over the last ten years. The combination of perovskites with classical...
10.09.2019 | Event News
04.09.2019 | Event News
29.08.2019 | Event News
13.09.2019 | Earth Sciences
13.09.2019 | Power and Electrical Engineering
13.09.2019 | Power and Electrical Engineering