Trimethylamine N-oxide
metaboliteTMAO promotes lipid oxidation, plaque inflammation and destabilization, increasing atherothrombotic rupture and thrombotic risk.
Pathway placement
Cascade stepLipid retention & oxidation
Confidencehigh
RationaleAtherosclerotic-burden predictor; plaque rupture and instability biomarker; MACE predictor in STEMI.
Also acts inVascular inflammation, Systemic / off-pathway, Cap degradation / rupture
Druggability
Not assessed (no mapped human gene target).
Type I vs Type II discrimination
ScoresLow-confidence (proxy)
R — rupture / Type-I69
C — confounder / Type-II60
A — assay feasibility42
E — evidence strength27
T1DI (composite)6
Specificity differential (R−C)+8.8
Confounder panel (Type-II drivers)
No confounder evidence retrieved.
Tier: light (literature co-occurrence proxy — lower confidence). See the discrimination table for all markers.
Assay & specimen
Class-level default (no specific cleared assay)— generic method inferred from analyte class; confirm against a specific product insert before use.
Specimen
Serum, plasma or urine
Collection tube
Serum separator (gold/red-top, SST) · Lithium heparin (green-top) · Sterile urine container
Method / principle
LC-MS/MS (targeted metabolomics) or enzymatic colorimetric where available
Reagent / substrate
Stable-isotope-labeled internal standard (MS); or enzyme-coupled Trinder reagent
Platform
LC-MS/MS; some automated chemistry
Turnaround · availability
Send-out / research · Specialized / research
Literature evidence(13)
- Plasma metabolomic profiling of patients with acute coronary syndrome treated with potent platelet inhibitors.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2026 · PMID 41564597 · doi
- Prognostic Value of Serum TMAO Measurement in Patients with STEMI: A Systematic Literature Review.Current vascular pharmacology · 2025 · PMID 39781720 · doi
- Association between Intestinal Flora Metabolites and Coronary Artery Vulnerable Plaque Characteristics in Coronary Heart Disease.British journal of hospital medicine (London, England : 2005) · 2025 · PMID 40135300 · doi
- Role of Trimethylamine N-Oxide in Assessing Plaque Instability of the Culprit Lesion in Chinese Patients With ST-Elevation Myocardial Infarction: Insights From a 7-Year Long-Term Follow-Up Study.Clinical and translational science · 2025 · PMID 40973984 · doi
- Gut microbiota and metabolomics profiles in patients with chronic stable angina and acute coronary syndrome.Physiological genomics · 2023 · PMID 37811721 · doi
- Cross-comparative metabolomics reveal sex-age specific metabolic fingerprints and metabolic interactions in acute myocardial infarction.Free radical biology & medicine · 2022 · PMID 35296425 · doi
- Positive Association of Plasma Trimethylamine-N-Oxide and Atherosclerosis in Patient with Acute Coronary Syndrome.Cardiovascular therapeutics · 2022 · PMID 36420057 · doi
- Circulating metabolites from the choline pathway and acute coronary syndromes in a Chinese case-control study.Nutrition & metabolism · 2020 · PMID 32489394 · doi
- Association of trimethylamine N-oxide with coronary atherosclerotic burden in patients with non-ST-segment elevation myocardial infarction.Medicine · 2020 · PMID 32629663 · doi
- Microbial Peer Pressure: The Role of the Gut Microbiota in Hypertension and Its Complications.Hypertension (Dallas, Tex. : 1979) · 2020 · PMID 33012206 · doi
- Plasma Trimethylamine N-Oxide as a Novel Biomarker for Plaque Rupture in Patients With ST-Segment-Elevation Myocardial Infarction.Circulation. Cardiovascular interventions · 2019 · PMID 30599768 · doi
- Association Between Plasma Trimethylamine N-oxide and Neoatherosclerosis in Patients With Very Late Stent Thrombosis.The Canadian journal of cardiology · 2019 · PMID 32595007 · doi
- Relation of Circulating Trimethylamine N-Oxide With Coronary Atherosclerotic Burden in Patients With ST-segment Elevation Myocardial Infarction.The American journal of cardiology · 2018 · PMID 30594289 · doi