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Multiple mechanisms of TMAO involved in CVD. (I) Delaying the action time of Ang - II, leading to continuous arterial spasm and activating MMP-2 pathway and ET-1; (II) Increase the expression of downstream inflammatory factors and ET-1 through MAPK pathway; (III) Activate TGF- β/ Smad pathway mediates fibrosis; (IV) Affect platelet function, increase blood lipid and blood viscosity.25–33
