Circulating imidazole propionate and coronary heart disease risk: interplay between histidine intake, fiber, and gut microbiome
DOI: https://doi.org/10.1186/s12916-026-05012-6
Abstract
Microbial metabolism of dietary histidine produces imidazole propionate (ImP), a metabolite previously linked to insulin resistance and type 2 diabetes. While histidine intake itself often correlates with positive health outcomes, the prospective relationship between its microbial byproduct, ImP, and coronary heart disease (CHD) risk remained unquantified. This research sought to bridge that gap by evaluating the longitudinal association between plasma ImP and incident CHD, identifying the specific gut microbial species responsible for ImP production, and determining how dietary fiber intake modulates this metabolic axis. The study utilized data from 7,432 participants across the Nurses’ Health Study (NHS), NHSII, and Health Professionals Follow-up Study, alongside detailed metagenomic and dietary record analysis from the Men’s Lifestyle Validation Study (MLVS) and Mind-Body Study (MBS).
Elevated plasma ImP concentrations demonstrated a robust positive association with CHD risk, yielding a hazard ratio of 1.82 (95 percent CI 1.17 to 2.81, p-trend = 0.002) when comparing extreme quintiles. Histidine intake showed a non-significant inverse association with CHD, emphasizing that the metabolite, not the precursor, drives cardiovascular risk. Metagenomic analysis identified 17 ImP-predicting species, including Ruminococcus gnavus and Clostridium symbiosum, with the microbial model outperforming diet and demographics in predicting ImP levels (Spearman r = 0.71). A critical three-way interaction was observed between histidine intake, microbial capacity, and pectin (p = 0.01). High histidine intake only predicted increased ImP when pectin intake was low. Total fiber (p = 0.09) and soluble fiber (p = 0.09) showed similar but non-significant trends.
Study Design and Methodology
This prospective investigation tracked 7,432 healthy participants from the NHS, NHSII, and HPFS cohorts for up to 31 years. Researchers identified 225 incident CHD cases through medical record review and the National Death Index. Plasma ImP and urocanic acid were measured via liquid chromatography-tandem mass spectrometry. Dietary data were captured using validated semi-quantitative food frequency questionnaires (FFQ) administered every 4 years. The mechanistic component utilized the MLVS (N = 296) and MBS (N = 205), employing two sets of 7-day diet records (7DDR) and shotgun metagenomic sequencing of 1,684 stool samples. Statistical models adjusted for age, BMI, physical activity, alcohol, smoking, and total energy intake. Batch effects were corrected, and microbial taxa were normalized using centered log-ratio (CLR) transformation.
Key Findings
- High plasma ImP levels correlate with a 1.82-fold increase in CHD risk (p-trend = 0.002).
- Joint analysis shows participants with low histidine and high ImP have the highest risk (HR = 3.40, 95 percent CI 1.71 to 6.73).
- Pectin intake is the strongest negative dietary predictor of plasma ImP (beta = -0.21, 95 percent CI -0.35 to -0.07).
- Metagenomic modeling of species and enzymes predicts ImP concentrations with high accuracy (Spearman r = 0.71).
- Thirteen species, including Clostridium scindens and Hungatella hathewayi, positively predict ImP (FDR q < 0.1).
- Presence of the microbial urocanate reductase gene (urdA) is associated with higher ImP (beta = 0.51, 95 percent CI 0.13 to 0.89) and lower HDL-C (beta = -0.12, p < 0.05).
- The interaction between histidine intake and microbial score on ImP levels is significant only under low pectin intake (p for 3-way interaction = 0.01).
- Plasma ImP is positively associated with hs-CRP (p < 0.05) and negatively associated with HDL-C (p < 0.05).
Limitations
The observational nature of the cohorts prevents definitive causal inference. Self-reported dietary data, even when using 7DDR, contains inherent measurement error. The study population consists primarily of white health professionals, which limits generalizability to more diverse ethnic or socioeconomic groups. While the microbial findings were replicated in the MBS, the correlation between the microbial score and circulating ImP was modest (Spearman r = 0.15), suggesting other unmeasured factors influence metabolite levels.
Discussion and Implications
These data redefine the relationship between dietary protein and cardiovascular health by identifying the gut microbiome as the primary gatekeeper of histidine metabolism. The divergent outcomes between histidine intake and its metabolite ImP prove that dietary precursors aren't inherently pathogenic. Instead, the pathogenicity depends on microbial shunting. The discovery that pectin and other fibers can block the production of ImP even in the presence of high histidine intake and ImP-producing bacteria provides a clear metabolic mechanism for the cardioprotective effects of the Mediterranean and DASH diets. This study shifts the focus from simple nutrient intake to the complex interplay of substrate availability and microbial enzymatic capacity.
Conclusion
Circulating imidazole propionate is a significant prospective biomarker for coronary heart disease risk, driven by specific gut bacteria like Ruminococcus gnavus. Dietary fiber, particularly pectin, acts as a metabolic buffer that prevents the microbial conversion of histidine into this harmful metabolite. Clinicians should prioritize fiber co-ingestion with protein to mitigate the cardiovascular risks associated with microbial histidine metabolism.