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Elevated plasma TMAO concentrations predict incident CVD risks in multiple clinical cohorts (47, 914), and both animal models with microbial transplantation (4, 15) and various studies on mice and humans with raised TMAO have revealed mechanistic and prognostic links between microbial TMAO production and both atherosclerosis and thrombosis, as well as chronic kidney disease and heart failure (46, 12, 13, 1618)

A high-fiber diet has been shown to reduce blood pressure, lessen heart hypertrophy and fibrosis, and boost the microbiota that produces acetate (150)

Participants then completed a maximal incremental exercise test on a Velotron cycle simulator (RacerMate, Inc