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Dietary sphingomyelin (SM) supplementation also remarkably decreased the atherosclerotic lesion area in the aortic arch in chow-fed ApoE / mice, reduced serum TMAO levels in C57BL/6 mice, and did not affect circulating SM levels or increase AS in ApoE / mice fed a HFD ( Regulating the Gut Microbiota to Reduce TMAO Levels Evidence from experimental and clinical studies has confirmed the role of the gut microbiota in TMAO metabolism, providing a theoretical basis for regulating the gut microbiota to control TMAO levels and prevent or treat AS (Wang et al., 2011