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Higher GBB levels were also associated with increased risk ofand poorer survival frommajor cardiovascular events (death, myocardial infarction, or stroke), but only when TMAO levels were also elevated.14 Continuing along the carnitine metabolism pathway to the liver, individual genetic variation may play a role in elevated TMAO levels by increasing conversion of TMA to TMAO by the enzyme flavin-containing monooxygenase 3 (FMO3)