Abstract
Tobacco use, hypertension, hyperglycemia, overweight, and inactivity are leading causes of overall and cardiovascular disease (CVD) mortality worldwide, yet the relevant metabolic alterations responsible are largely unknown. We conducted a serum metabolomic analysis of 620 men in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (1985-2013). During 28 years of follow-up, there were 435 deaths (197 CVD and 107 cancer). The analysis included 406 known metabolites measured with ultra-high performance liquid chromatography/mass spectrometry-gas chromatography/mass spectrometry. Cox regression estimated mortality hazard ratios (HR) for a one standard-deviation difference in metabolite-signals, and we divided the data into training and test-sets, creating a metabolite risk score of the strongest metabolites in the former to test in the latter. The strongest associations with overall mortality were N-acetylvaline (HR=1.28; P<4.1×10-5, below Bonferroni statistical threshold), and dimethylglycine, 7-methylguanine, C-glycosyltryptophan, taurocholate, and N-acetyltryptophan (1.23≤HR≤1.32; 5×10-5≤P≤1×10-4). C-Glycosyltryptophan, 7-methylguanine, and 4-androsten-3beta,17beta-diol disulfate were statistically significantly associated with CVD mortality (1.49≤HR≤1.62, P<4.1×10-5). No metabolite was associated with cancer mortality at false discovery rate<0.1. Individuals with a one standard-deviation higher metabolite risk score had increased all-cause and CVD mortality in the test-set (HR=1.4, P=0.05; HR=1.8, P=0.003, respectively). The several serum metabolites and their composite risk score independently associated with all-cause and CVD mortality may provide potential leads regarding the molecular basis of mortality.Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174,00302841026182,alsfakia@gmail.com
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