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Elevated plasma TMAO concentrations predict incident CVD risks in multiple clinical cohorts (47, 914), and both animal models with microbial transplantation (4, 15) and various studies on mice and humans with raised TMAO have revealed mechanistic and prognostic links between microbial TMAO production and both atherosclerosis and thrombosis, as well as chronic kidney disease and heart failure (46, 12, 13, 1618)

Participants then completed a maximal incremental exercise test on a Velotron cycle simulator (RacerMate, Inc

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