Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Cardiol. Mar 26, 2026; 18(3): 116780
Published online Mar 26, 2026. doi: 10.4330/wjc.v18.i3.116780
Published online Mar 26, 2026. doi: 10.4330/wjc.v18.i3.116780
Gut microbiota-derived metabolite trimethylamine N-oxide in major adverse cardiovascular events: Mechanisms, risk assessment, and therapeutic strategies
Samuel Jaimez Alvarado, María Fernanda Flores Enciso, María Magdalena Aguirre García, Unidad de Investigación UNAM-INC, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 14080, Ciudad de México, Mexico
Amedeo Amedei, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Tuscany, Italy
Co-corresponding authors: Amedeo Amedei and María Magdalena Aguirre García.
Author contributions: Jaimez Alvarado S, Flores Enciso MF, Amedei A, and Aguirre García MM contributed to review and editing, writing original draft, and conceptualization; Amedei A and Aguirre García MM contributed to funding acquisition and made equal contributions as co-corresponding authors; Aguirre García MM contributed to supervision. All authors approved the final version to publish.
Supported by Dirección General de Asuntos del Personal Académico-Programa de Apoyo a Proyectos de Investigación e Innovación Tecnológica, No. IN219025; and Consejo Nacional de Humanidades, Ciencias y Tecnologías, No. CBF2023-2024-734.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Amedeo Amedei, Full Professor, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, Florence 50134, Tuscany, Italy. amedeo.amedei@unifi.it
Received: November 20, 2025
Revised: December 22, 2025
Accepted: January 29, 2026
Published online: March 26, 2026
Processing time: 123 Days and 14 Hours
Revised: December 22, 2025
Accepted: January 29, 2026
Published online: March 26, 2026
Processing time: 123 Days and 14 Hours
Core Tip
Core Tip: Trimethylamine N-oxide (TMAO) is increasingly proposed as a prognostic biomarker and therapeutic target in cardiovascular disease, yet its clinical signal is strongly shaped by renal function and cardiometabolic comorbidity. We synthesize evidence linking TMAO to risk stratification, including incremental value beyond GRACE in acute coronary syndrome, highlight mechanistic advances from microbiota-targeted trimethylamine-lyase inhibitors, 3,3-dimethyl-1-butanol/fluoromethylcholine, that improve vascular and cardiac phenotypes in preclinical models, and outline a precision-nutrition framework that tailors TMAO-lowering strategies to individual producer metabotypes.