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found that TMAO can inhibit the RCT process and affect cholesterol metabolism ( ApoE / mice, and further activate the nuclear receptors farnesoid-X-receptor (FXR) and small heterodimer partner (SHP), to reduce the expression of cholesterol 7-hydroxylase (Cyp7a1) to inhibit bile acid synthesis, thus accelerating the formation of atherosclerosis (82)

A medication review may be necessary, particularly if the patient is taking multiple glucose-lowering agents or antihypertensive medications

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10.1096/fj.11-186460 FASEB J