Croyal M, Saulnier PJ, Aguesse A, et al. - In view of the observation that trimethylamine N-oxide (TMAO) interferes with atherosclerosis and diabetes pathophysiology, researchers sought to establish the association between TMAO and major adverse cardiovascular events (MACE) specifically in type 2 diabetes (T2D). A single-center prospective cohort of consecutively recruited patients with T2D was examined for the correlation of plasma TMAO concentrations with MACE and all-cause mortality. Among 1,463 SURDIENE participants (58% men) (aged 65±10 years), significant link was observed between TMAO concentrations and diabetes duration, renal function, HDL-Cholesterol, sTNFR1 concentrations. Patients on metformin had significantly higher TMAO concentrations, even after adjustment for eGFR. Significant association was observed of MACE-free survival and all-cause mortality with the quartile distribution of TMAO concentrations, patients with the highest TMAO levels exhibiting the greatest risk of outcomes. This suggests the role of dysbiosis in cardiovascular risk, in T2D patients.