TMAO, A Gut Microbiome Derived Metabolite, and its Contribution to the Development of Cardiovascular Disease (CVD)

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, with atherosclerosis as its primary driver. While traditional risk factors are well-understood, the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) is an emerging, critical determinant of cardiovascular health. This systematic review evaluates the mechanistic links between TMAO and atherosclerosis, drawing from animal and human studies, and assesses the efficacy of dietary, microbial, and pharmacological interventions. Elevated TMAO levels consistently correlate with platelet hyperreactivity, endothelial dysfunction, and vascular inflammation. Interventions like the Mediterranean diet, exercise, and enzyme inhibitors like berberine show significant potential in reducing TMAO levels and mitigating CVD risk.