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TMAO alters how cholesterol is metabolized so less is eliminated from the body, allowing more cholesterol to deposit and harden into the artery walls (atherosclerosis)

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Wanner C, Forstner-Wanner S, Rossle C, Furst P, Schollmeyer P, Horl WH: Carnitine metabolism in patients with chronic renal failure: effect of L-carnitine supplementation