Circulating citric acid cycle metabolites and risk of cardiovascular disease in the PREDIMED study

J.L. Santos, M. Ruiz-Canela, C. Razquin, C.B. Clish, M. Guasch-Ferre, N. Babio, D. Corella, E. Gomez-Gracia, M. Fiol, R. Estruch, J. Lapetra, M. Fito, F. Aros, L. Serra-Majem, L. Liang, M.Á. Martinez, E. Toledo, J. Salas-Salvado, F.B Hu

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Resum

Background and aim
Plasma citric acid cycle (CAC) metabolites might be likely related to cardiovascular disease (CVD). However, studies assessing the longitudinal associations between circulating CAC-related metabolites and CVD risk are lacking. The aim of this study was to evaluate the association of baseline and 1-year levels of plasma CAC-related metabolites with CVD incidence (a composite of myocardial infarction, stroke or cardiovascular death), and their interaction with Mediterranean diet interventions.
Methods and results
Case-cohort study from the PREDIMED trial involving participants aged 55–80 years at high cardiovascular risk, allocated to MedDiets or control diet. A subcohort of 791 participants was selected at baseline, and a total of 231 cases were identified after a median follow-up of 4.8 years. Nine plasma CAC-related metabolites (pyruvate, lactate, citrate, aconitate, isocitrate, 2-hydroxyglutarate, fumarate, malate and succinate) were measured using liquid chromatography-tandem mass spectrometry. Weighted Cox multiple regression was used to calculate hazard ratios (HRs). Baseline fasting plasma levels of 3 metabolites were associated with higher CVD risk, with HRs (for each standard deviation, 1-SD) of 1.46 (95%CI:1.20–1.78) for 2-hydroxyglutarate, 1.33 (95%CI:1.12–1.58) for fumarate and 1.47 (95%CI:1.21–1.78) for malate (p of linear trend <0.001 for all). A higher risk of CVD was also found for a 1-SD increment of a combined score of these 3 metabolites (HR = 1.60; 95%CI: 1.32–1.94, p trend <0.001). This result was replicated using plasma measurements after one-year. No interactions were detected with the nutritional intervention.
Conclusion
Plasma 2-hydroxyglutarate, fumarate and malate levels were prospectively associated with increased cardiovascular risk.
Clinical trial number
ISRCTN35739639
Idioma originalAnglès
Pàgines (de-a)835-843
Nombre de pàgines9
RevistaNutrition, Metabolism and Cardiovascular Diseases
Volum33
Número4
DOIs
Estat de la publicacióPublicada - d’abr. 2023

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