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This complex metabolic disorder is accompanied by an increase in local and systemic inflammatory mediators, such as proinflammatory cytokines [e.g., interleukin (IL)-6 and IL-8 and tumor necrosis factor-alpha (TNF-)] [9, 10]

Production of large amounts of proinflammatory cytokines and ROS hyperproduction cause NF- B activation, a central event in the inflammatory response and further production of inflammatory cytokines [34, 35, 38]

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Statins, for example, have been associated with a decrease in TMAO in multiple studies, including those from cardiac catheterization registries

27 Wilcox et al 26 reported that the effects of 3 different choline sources and forms containing similar amounts of choline (approximately 450 mg) on plasma TMAO levels were not the same

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