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In conclusion, this review outlines that a possible future precision approach to cardiovascular prevention would integrate gut and oral microbiome profiling, LC-MS/MS TMAO quantification, and a selected panel of circulating miRNAs into care pathways, which could trigger individualized interventions (dietprobiotics/berberineperiodontal management) with longitudinal monitoringand would be enabled by assay standardization, multicenter RCTs to define actionable thresholds and identify responders, and EHR-integrated decision support that could drive guideline adoption