To the Editor: Smoking remains a chief concern
Written by W.E. Feeman Jr. MD   
Wednesday, 15 May 2013 10:06
Recent newscasts have given a lot of coverage to Stan Hazen, MD's findings that gut bacteria metabolize foods rich in lecithin (red meat, eggs, etc) into a substance named traimeathylamine-N-oxide (TMAO).  
TMAO in turn is associated with an increased rate of atherothrombotic disease (ATD) events, even in lower risk patients.  (The fact that Dr. Hazen did not use ratios, however, limits his comments on "low risk" patients.)   This finding has been reported by newscasters as being revolutionary and they have hinted that this may be the most important risk factor for ATD.  Those conclusions are over-reaching and do not in any way interfere with all the risk factor data reported over the years in this newspaper by me and others.  
No one should turn his/her back on all the research done in the field of ATD prediction and regression over the years.  That would be a tragic and probably fatal mistake.
That there is an association between TMAO and ATD is clear.  I believe that that association is by thrombosis (blood clot formation) and Dr. Hazen agrees.  Since cigarette smoking is known  to cause thrombosis and is a major cause of ATD events, the interaction between TMAO and cigarette needs to be worked out.
If TMAO turns out to be independent of cigarette smoking, then stricter attention to diet is probably warranted.  Dr. Hazen has opened up a whole new field of research however.  Later on this year I will be presenting a three-poster series at the National Lipid Association symposium which will explore the implications of Dr. Hazen's work, and on how one treats dyslipidemia may be as important as how well one treats dyslipidemia.

W.E. Feeman Jr. MD
Bowling Green

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