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The mechanisms by which TMAO raises CV risk and accelerates atherosclerosis are not well understood, but studies have shown that TMAO arising from both choline and L-carnitine supplementation in mice may inhibit reverse cholesterol transport 35 and enhance foam cell formation in both arterial and peritoneal cavity 47

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However, in many cases peripheral symptoms, such as muscle fatigue, either prevail or are an important part of the clinical presentation

RahmelTHbnerMKoosBWolfAWillemsenKStrauGet al

Certain treatments also address muscle tone and skin laxity

In: Vermelho AB, Couri S, editors