Association of choline and betaine with the risk of cardiovascular disease and all‐cause mortality: Meta‐analysis

Abstract Background This study aimed to systematically evaluate the role of circulating levels of choline and betaine in the risk of cardiovascular disease (CVD) and all‐cause mortality by comprehensively reviewing observational studies. Methods This study was conducted according to PRISMA 2020 statement. Six electronic databases, including PubMed, Embase and China National Knowledge Infrastructure (CNKI), were searched for cohort studies and derivative research design types (nested case–control and case‐cohort studies) from the date of inception to March 2022. We pooled relative risk (RR) and 95% confidence interval (CI) of the highest versus lowest category and per SD of circulating choline and betaine concentrations in relation to the risk of CVD and all‐cause mortality. Results In the meta‐analysis, 17 studies with a total of 33,009 participants were included. Random‐effects model results showed that highest versus lowest quantile of circulating choline concentrations were associated with the risk of CVD (RR = 1.29, 95% CI: 1.04–1.61) and all‐cause mortality (RR = 1.62, 95% CI: 1.12–2.36). We also observed the risk of CVD were increased 13% (5%–22%) with per SD increment. Furthermore, highest versus lowest quantile of circulating betaine concentrations were not associated with the risk of CVD (RR = 1.07, 95% CI: 0.92–1.24) and all‐cause mortality (RR = 1.39, 95% CI: 0.96–2.01). However, the risk of CVD was increased 14% (5%–23%) with per SD increment. Conclusions Higher levels of circulating choline were associated with a higher risk of CVD and all‐cause mortality.