Plasma Metabolite N-Formylmethionine Is Associated With Higher Blood Pressure in the Multiethnic HELIUS Cohort and Triggers Vascular Dysfunction

BACKGROUND: Since the existing literature on plasma metabolites and blood pressure (BP) is predominantly focused on populations of European ancestry, we aimed to study associations between metabolite profiles and BP in a multiethnic cohort.

METHODS: From the HELIUS study (Healthy Life in an Urban Setting), 369 individuals of Dutch, Ghanaian, African Surinamese, and South-Asian Surinamese ethnicity were included for a cross-sectional analysis. Office BP was recorded, and plasma metabolites were measured using untargeted liquid chromatography tandem mass spectometry. Associations between metabolite profiles and BP were assessed with XGBoost machine learning prediction models, followed by linear regression models. The associations with the highest-ranked metabolite were validated in 2 cohorts, and its effects were investigated in human aortic endothelial and vascular smooth muscle cells.

RESULTS: The plasma metabolite N-formylmethionine (fMet) showed the most consistent associations with BP across age, sex, and ethnicity. Notably, fMet was associated with higher systolic (+4.14 mm Hg, 95% CI, 2.11-6.17 per SD increase) and diastolic BP (+2.61 mm Hg, 1.41-3.82), and these associations were validated in 2 independent cohorts. Mechanistically, we found that fMet likely contributes to elevated BP by suppressing endothelial nitric oxide synthase expression, and inducing oxidative stress and mitochondrial dysfunction in endothelial cells. In addition, fMet elicited an early inflammatory response, disrupted the endothelial barrier and upregulated myosin light chain expression in vascular smooth muscle.

CONCLUSIONS: We identified the metabolite fMet as a novel independent factor associated with BP in an ethnically diverse population. It likely contributes to higher BP by triggering endothelial cell dysfunction, while augmenting contractile proteins in vascular smooth muscle cells.