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While elevated plasma concentrations of L-carnitine are associated with increased risk of cardiovascular incidentssuch as heart attack, stroke, and deathindependent of traditional CVD risk factors, this appears to only be true when TMAO is also elevated.6 Proposed mechanisms include effects on cholesterol, the hormone angiotensin IIwhich can raise blood pressure, and increased platelet clumping, possibly leading to blood clots.7.8 A 2020 cross-sectional study using data from 1,653 participants in the Multiethnic Cohort Study identified several associations of plasma levels of TMAO and its precursors, including carnitine, with inflammatory and cardiometabolic biomarkers