Objective To systematically evaluate the relation between intestinal flora metabolic products trimethylamine N⁃oxide (TMAO) and cardiovascular disease (CVD). Methods Literature related to the correlation between TMAO and CVD was enrolled through retrieving databases such as PubMed, The Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP by computer. After screening enrolled literature, extracting data, and evaluating quality, R language 4.4 software was adopted to perform a Meta⁃analysis. Results A total of 18 literature was enrolled, including 18 046 research subjects, therein there was 4985 CVD patients, and 13 061 controlled individuals. The results of Meta⁃analysis revealed that the CVD group exhibited higher peripheral blood TMAO level compared with the control group (P<0.05); furthermore, the elevated peripheral blood TMAO level was the risk factor for the occurrence of CVD (P<0.05). Conclusion Elevated intestinal flora metabolic products TMAO level is the risk factor for the occurrence of CVD, which can provide an evidence⁃based basis for CVD control and prevention.

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