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One major limitation of this study beyond its retrospective design is that patients who received L-carnitine had a significantly different clinical presentation

TMAO Reduces Vascular Tone Endothelial dysfunction is associated with abnormal changes in the vascular tone, which is regulated by the production of at least three vasoactive factors, nitric oxide (NO), prostaglandin I 2 (PGI 2 ), and endothelium-derived hyperpolarization (EDH) [3,58,84,85,86]

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Oral bacteria such as Prevotella , Fusobacterium , Porphyromonas , and Streptococcus are capable of metabolizing dietary choline into trimethylamine (TMA), which is subsequently converted to TMAO in the liver