Please wait a minute...
Reviews in Cardiovascular Medicine  2019, Vol. 20 Issue (3): 121-128     DOI: 10.31083/j.rcm.2019.03.518
Review Previous articles | Next articles
Diet-induced chronic syndrome, metabolically transformed trimethylamine-N-oxide, and the cardiovascular functions
Shanna J. Hardin1, Mahavir Singh1, *(), Wintana Eyob1, Jack C. Molnar1, Rubens P. Homme1, Akash K. George1, Suresh C. Tyagi1
1 Department of Physiology, University of Louisville School of Medicine Louisville, Kentucky 40202, USA
Download:  PDF(1040KB)  ( 1497 ) Full text   ( 61 )
Export:  BibTeX | EndNote (RIS)      

Recent studies have shown that the integrity of the gastrointestinal tract and its microbiome impact the functioning of various body systems by regulating immunological responses, extracting energy, remodeling intestinal epithelia, and strengthening the gut itself. The gastrointestinal tract microbiota includes bacteria, fungi, protozoa, viruses, and archaea which collectively comprise a dynamic community prone to alterations via influences such as the environment, illness, and metabolic processes. The idea that the host’s diet possesses characteristics that could potentially alter microbiota composition is a novel notion. We hypothesize that a high fat diet leads to the alteration of the gastrointestinal microbiota composition and that metabolic transformation of the compound trimethylamine into trimethylamine-N-oxide promotes vasculopathy such as atherosclerosis and affects cardiovascular functionality. Furthermore, we hypothesize that treatment with probiotics will restore the homeostatic environment (eubiosis) of the gastrointestinal tract.

Key words:  Diet      dysbiosis      eubiosis      cardiovascular disease      inflammation      phosphatidylcholine      probiotics     
Submitted:  30 June 2019      Accepted:  02 September 2019      Published:  30 September 2019     
  • HL74185, HL139047, AR-71789/NIH grants
*Corresponding Author(s):  Mahavir Singh     E-mail:

Cite this article: 

Shanna J. Hardin, Mahavir Singh, Wintana Eyob, Jack C. Molnar, Rubens P. Homme, Akash K. George, Suresh C. Tyagi. Diet-induced chronic syndrome, metabolically transformed trimethylamine-N-oxide, and the cardiovascular functions. Reviews in Cardiovascular Medicine, 2019, 20(3): 121-128.

URL:     OR

Figure 1.  (A) A schematic illustrating the effects of diet on gut microbiome and subsequent consequences. Mice that were given a regular chow diet maintained the eubiotic gastrointestinal environment. The eubiotic environment did not promote the accumulation of TMAO or significantly alter cardiovascular functionality. (B) Mice that were fed HFD developed a dysbiotic gastrointestinal environment that supported the accumulation of TMAO and altered the cardiovascular functions. Proposed treatment with probiotic (s) supplementation may decrease some harm as caused by the HFD through mitigating deleterious effects induced by an unhealthy diet by reconstituting the microbial lining of the gut with the healthy microbes.

Figure 2.  Representation of how TMAO accumulates in the body because of the ingestion of dietary PC. The choline portion of the PC is metabolized into TMA by gastrointestinal microbes. The TMA then travels to the liver, via the bloodstream, where it is converted into TMAO by hepatic FMOs. A skeletal structure for the TMAO molecule (boxed in red color) is implicated in developing cardiovascular diseases by enhancing atherosclerotic factors. The precursor of TMAO that is TMA is produced in GIT as a byproduct of the metabolization of choline/PC by gut microbiota. The resulting gaseous TMA enters the circulatory system where it is converted into TMAO (boxed in red color) by hepatic FMOs (Eswaramoorthy et al., 2006). The FMOs are responsible for oxygenating lipophilic compounds so that they can be solubilized and rapidly excreted (FMOs selectively oxygenizes the nucleophilic nitrogen in the amine group producing the TMAO molecules) (Eswaramoorthy et al., 2006).

Figure 3.  A visual depiction of the stepwise mechanism connecting TMAO and the enhancement of atherosclerotic factors. TMAO is produced in the liver by FMOS. The increased plasma concentration of TMAO promotes the upregulation of macrophage scavenger receptors. The stimulated scavenger receptors promote inflammation and gobble-up the macrophages. Furthermore, the accumulated macrophages produce foamy cells because of their inability to properly metabolize lipids inside them. In summary, the accumulation of macrophages, foamy cells, and inflammation together promote the development of atherosclerosis.

1 Al-Obaide, M. A. I., Singh, R., Datta, P., Rewers-Felkins, K. A., Salguero, M. V., Al-Obaidi, I., KottapalliK. and Vasylyeva, T. L. (2017). Gut microbiota-dependent trimethylamine-N-oxide and serum biomarkers in patients with T2DM and advanced CKD. Journal of Clinical Medicine 6, E86.
2 Al-Rubaye, H., Perfetti, G. and Kaski, J. C. (2019). The Role of Microbiota in Cardiovascular Risk: Focus on Trimethylamine Oxide. Current Problems in Cardiology 44, 182-196.
3 Barrea, L., Annunziata, G., Muscogiuri, G., Di Somma, C., Laudisio, D., Maisto, M., deAlteriis, G., Tenore G., C., Colao, A. and Savastano, S. (2018). Trimethylamine- N-oxide (TMAO) as novel potential biomarker of early predictors of metabolic syndrome. Nutrients 10, E1971.
4 Barrea, L., Annunziata, G., Muscogiuri, G., Laudisio, D., Di Somma, C., Maisto, M., Tenore, G.C., Colao, A. and Savastano, S. (2019). Trimethylamine N-oxide, Mediterranean diet, and nutrition in healthy, normal-weight adults: also a matter of sex? Nutrition 62, 7-17.
5 Barrea, L., Muscogiuri, G., Annunziata, G., Laudisio, D., de Alteriis, G., Tenore, G. C., Colao, A. and Savastano, S. (2019). A new light on vitamin d in obesity: a novel association with Trimethylamine-N-Oxide (TMAO). Nutrients 11, E1310.
6 Brial, F., Le Lay, A., Dumas, M.-E. and Gauguier, D. (2018). Implication of gut microbiota metabolites in cardiovascular and metabolic diseases. Cellular and Molecular Life Sciences 75, 3977-3990.
7 Bu, J. and Wang, Z. . (2018). Cross-talk between gut microbiota and heart via the routes of metabolite and immunity. Gastroenterology Research and Practice 2018, 8.
8 Charach, G., Rabinovich, A., Argov, O., Weintraub, M. and Rabinovich, P. (2012). The role of bile Acid excretion in atherosclerotic coronary artery disease. Intternational Journal of Vascular Medicine 2012, 949672.
9 Charach, G., Rabinovich, P. D., Konikoff, F. M., Grosskopf, I., Weintraub, M. S. and Gilat, T. (1998). Decreased fecal bile acid output in patients with coronary atherosclerosis. Journal of Medicine 29, 125-136.
10 Chen, K., Zheng, X., Feng, M., Li, D. and Zhang, H. (2017). Gut microbiota-dependent metabolite trimethylamine N-oxide contributes to cardiac dysfunction in western diet-induced obese mice. Frontiers in Physiology 8, 139.
11 Cheung, W., Keski-Rahkonen, P., Assi , N., Ferrari, P., Freisling, H., Rinaldi, S., Slimani, N., Zamora-Ros, R., Rundle, M., Frost, G., Gibbons, H., Carr, E., Brennan, L., Cross, A. J., Pala, V., Panico, S., Sacerdote, C., Palli, D., Tumino, R., Kühn, T., Kaaks, R., Boeing, H., Floegel, A., Mancini, F., Boutron-Ruault, M. C., Baglietto, L., Trichopoulou, A., Naska, A., Orfanos, P. and Scalbert, A. (2017). A metabolomic study of biomarkers of meat and fish intake. American Journal of Clinical Nutrition 105, 600-608.
13 Cho, C. E., Taesuwan, S., Malysheva, O. V., Bender, E., Tulchinsky, N. F., Yan, J., Sutter, J. L. and Caudill, M. A. (2017). Trimethylamine-N-oxide (TMAO) response to animal source foods varies among healthy young men and is influenced by their gut microbiota composition: A randomized controlled trial. Molecular Nutrition & Food Research 61, 1600324.
14 Donaldson, G. P., Lee, S. M. and Mazmanian, S. K. (2016). Gut biogeography of the bacterial microbiota. Nature reviews. Microbiology 14, 20-32.
15 Eswaramoorthy, S., Bonanno, J. B., Burley, S. K. and Swaminathan, S. (2006). Mechanism of action of a flavin-containing monooxygenase. Proceedings of the National Academy of Sciences 103, 9832.
16 Falony, G., Vieira-Silva, S. and Raes , J. (2015). Microbiology Meets Big Data: The Case of Gut Microbiota-Derived Trimethylamine. Annual Review of Microbiology 69, 305-321.
17 Feingold, K. R. and Elias, P. M. (2014). Role of lipids in the formation and maintenance of the cutaneous permeability barrier. Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids 1841, 280-294.
18 Fukami, K., Yamagishi, S., Sakai, K., Kaida, Y., Yokoro, M., Ueda, S., Wada, Y., Takeuchi, M., Shimizu, M., Yamazaki, H. and Okuda, S. (2015). Oral L-carnitine supplementation increases trimethylamine-N-oxide but reduces markers of vascular injury in hemodialysis patients. N-oxide but reduces markers of vascular injury in hemodialysis patients. Journal of Cardiovascular Pharmacology 65, 289-295.
19 Gallistl, S., Sudi, K., Mangge, H., Erwa, W. and Borkenstein, M. (2000). Insulin is an independent correlate of plasma homocysteine levels in obese children and adolescents. Diabetes Care 23, 1348-1352.
20 Howarth, F. C., Qureshi, M. A., Gbewonyo, A. J., Tariq, S. and Adeghate, E. (2005). The progressive effects of a fat enriched diet on ventricular myocyte contraction and intracellular Ca2+ in the C57BL/6J mouse . Molecular and Cellular Biochemistry 273, 87-95.
21 Huc, T., Drapala, A., Gawrys, M., Konop, M., Bielinska, K., Zaorska, E., Samborowska, E., Wyczalkowska-Tomasik, A., Pączek, L., Dadlez, M. and Ufnal, M. (2018). Chronic, low-dose TMAO treatment reduces diastolic dysfunction and heart fibrosis in hypertensive rats. American Journal of Physiology- Heart and Circulatory Physiology 315, H1805-H1820.
22 Jama, H. A., Kaye, D. M. and Marques, F. Z. (2019). The gut microbiota and blood pressure in experimental models. Current Opinion in Nephrology and Hypertension 28, 97-104.
23 Janeiro, M. H., Ramírez, M. J., Milagro, F. I., Martínez, J. A. and Solas, M. (2018). Implication of trimethylamine N-Oxide (TMAO) in disease: potential biomarker or new therapeutic target. Nutrients 10, 1398.
24 Jia, L., Betters, J. L. and Yu, L. (2011). Niemann-pick C1-like 1 (NPC1L1) protein in intestinal and hepatic cholesterol transport. Annual Review of Physiology 73, 239-259.
25 Jones, S. A., Gibson, T., Maltby, R. C., Chowdhury, F. Z., Stewart, V., Cohen, P. S. and Conway, T. (2011). Anaerobic respiration of Escherichia coli in the mouse intestine. Infection and Immunity 79, 4218-4226.
26 Krajmalnik-Brown, R., Ilhan, Z. E., Kang, D. W. and DiBaise, J. K. (2012). Effects of gut microbes on nutrient absorption and energy regulation. Nutrition in Clinical Practice 27, 201-214.
27 Makki, K., Deehan, E. C., Walter, J. and Backhed, F. (2018). The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host & Microbe 23, 705-715.
28 Jonsson, A. L. and Backhed, F. (2017). Role of gut microbiota in atherosclerosis. Nature Reviews Cardiology 14, 79-87.
29 Kanitsoraphan, C., Rattanawong, P., Charoensri, S. and Senthong, V. (2018). Trimethylamine N-Oxide and Risk of Cardiovascular Disease and Mortality. Current Nutrition Reports 7, 207-213.
30 Koeth, R. A., Wang, Z., Levison, B. S., Buffa, J. A., Org, E., Sheehy, B. T., Britt, E.B., Fu, X., Wu, Y., Li, L., Smith, J. D., DiDonato, J.A., Chen, J., Li, H., Wu, G.D., Lewis, J. D., Warrier, M., Brown, J.M., Krauss, R.M., Tang, W.H., Bushman, F.D., Lusis, A. J. and Hazen, S. L. (2013) Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature medicine 19, 576-585.
31 Kuhn, T., Rohrmann, S., Sookthai, D., Johnson, T., Katzke, V., Kaaks, R., von Eckardstein, A. and Muller, D. (2017). Intra-individual variation of plasma trimethylamine-N-oxide (TMAO), betaine and choline over 1 year. Clinical Chemistry and Laboratory Medicine 55, 261-268.
32 Kzhyshkowska, J., Neyen, C. and Gordon, S. (2012). Role of macrophage scavenger receptors in atherosclerosis. Immunobiology 217, 492-502.
33 Le Barz, M., Daniel, N., Varin, T. V., Naimi, S., Demers-Mathieu, V., Pilon, G., Audy, J., Laurin, É., Roy, D., Urdaci, M.C., St-Gelais, D., Fliss, I. and Marette, A. (2019). In vivo screening of multiple bacterial strains identifies Lactobacillus rhamnosus Lb102 and Bifidobacterium animalis ssp. lactis Bf141 as probiotics that improve metabolic disorders in a mouse model of obesity. The FASEB Journal 33, 4921-4935.
35 Leustean, A. M., Ciocoiu, M., Sava, A., Costea, C. F., Floria, M., Tarniceriu, C. C. and Tanase, D. M. (2018). Implications of the intestinal microbiota in diagnosing the progression of diabetes and the presence of cardiovascular complications. Journal of Diabetes Research 2018, 5205126.
36 Li, T., Chen, Y., Gua, C. and Li, X. (2017). Elevated circulating trimethylamine N-Oxide levels contribute to endothelial dysfunction in aged rats through vascular inflammation and oxidative stress. Frontiers in Physiology 8, 350.
37 Li, T., Gua, C., Wu, B. and Chen, Y. (2018). Increased circulating trimethylamine N-oxide contributes to endothelial dysfunction in a rat model of chronic kidney disease. Biochemical and Biophysical Research Communication 495, 2071-2077.
38 Lu, Y., Feskens, E. J., Boer, J. M. and Muller, M. (2010). The potential influence of genetic variants in genes along bile acid and bile metabolic pathway on blood cholesterol levels in the population. Atherosclerosis 210, 14-27.
39 Ma, G., Pan, B., Chen, Y., Guo, C., Zhao, M., Zheng, L. and Chen, B. (2017). Trimethylamine N-oxide in atherogenesis: impairing endothelial self-repair capacity and enhancing monocyte adhesion. Bioscience reports 37, BSR20160244.
40 Ma, J. and Li, H. (2018). The Role of Gut Microbiota inAtherosclerosis and Hypertension. Frontiers in Pharmacology 9, 1082.
41 Martinez, K. B., Leone, V. and Chang, E. B. (2017). Western diets, gut dysbiosis, and metabolic diseases: Are they linked? Gut Microbes 8, 130-142.
42 Martinic, A., Barouei, J., Bendiks, Z., Mishchuk, D., Heeney, D. D., Martin, R., Marco, M. L. and Slupsky, C. M. (2018). Supplementation of Lactobacillus plantarum Improves Markers of Metabolic Dysfunction Induced by a High Fat Diet. Journal of Proteome Research 17, 2790-2802.
43 Meyer, K. A., Benton, T. Z., Bennett, B. J., Jacobs, D. R., Jr., Lloyd-Jones, D. M., Gross, M. D., Carr, J. J, Gordon-Larsen, P. and Zeisel, S. H. (2016). Microbiota-Dependent Metabolite Trimethylamine N-Oxide and Coronary Artery Calcium in the Coronary Artery Risk Development in Young Adults Study (CARDIA). Journal of the American Heart Association 5, e003970.
44 Nam, H. S. (2019). Gut Microbiota and Ischemic Stroke: The Role of Trimethylamine N-Oxide. Journal of Stroke 21, 151-159.
45 Nehra, V., Allen, J. M., Mailing, L. J., Kashyap, P. C. and Woods, J. A. (2016). Gut Microbiota: Modulation of Host Physiology in Obesity. Physiology (Bethesda) 31, 327-335.
46 Peng, J., Xiao, X., Hu, M. and Zhang, X. (2018). Interaction between gut microbiome and cardiovascular disease. Life Sci, 214, 153-157.
47 Pikuleva, I. A. (2006). Cytochrome P450s and cholesterol homeostasis. Pharmacology & Therapeutics 112, 761-773.
48 Randrianarisoa, E., Lehn-Stefan, A., Wang, X., Hoene, M., Peter, A., Heinzmann, S. S., Zhao X, Königsrainer I, Königsrainer A, Balletshofer B, Machann J, Schick F, Fritsche A, Häring H U, Xu G, Lehmann R. and Stefan, N. (2016). Relationship of Serum Trimethylamine N-Oxide (TMAO) Levels with early Atherosclerosis in Humans. Scientific reports 6, 26745-26745.
49 Rajoka, M. S. R., Shi, J., Mehwish, H. M., Zhu, J., Li, Q., Shao, D., Qingsheng, H. and Yang, H. (2017). Interaction between diet composition and gut microbiota and its impact on gastrointestinal tract health. Food Science and Human Wellness 6, 121-130.
50 Romano, K. A., Vivas, E. I., Amador-Noguez, D. and Rey, F. E. (2015). Intestinal microbiota composition modulates choline bioavailability from diet and accumulation of the proatherogenic metabolite trimethylamine-N-oxide. MBio 6, e02481-14.
51 Seldin, M. M., Meng, Y., Qi, H., Zhu, W., Wang, Z., Hazen, S. L., Lusis, A. J. and Shih, D. M. (2016). Trimethylamine N-Oxide Promotes Vascular Inflammation Through Signaling of Mitogen-Activated Protein Kinase and Nuclear Factor-kappaB. Journal of the American Heart Association 5, e002767.
52 Shafi, T., Powe, N. R., Meyer, T. W., Hwang, S., Hai, X., Melamed, M. L., Banerjee, T., Coresh, J., Hostetter, T. H. (2017). Trimethylamine N-Oxide and Cardiovascular Events in Hemodialysis Patients. Journal of the American Society of Nephrology 28, 321-331.
53 Stender, S., Frikke-Schmidt, R., Nordestgaard, B. G. and Tybjaerg-Hansen, A. (2014). The ABCG5/8 cholesterol transporter and myocardial infarction versus gallstone disease. Journal of the American College of Cardiology 63, 2121-2128.
54 Stremmel, W., Schmidt, K. V., Schuhmann, V., Kratzer, F., Garbade, S. F., Langhans, C. D., Fricker, G. and Okun, J. G. (2017). Blood Trimethylamine-N-Oxide originates from microbiota mediated breakdown of phosphatidylcholine and absorption from small intestine. PloS One 12, e0170742-e0170742.
55 Tang, W. H. W., Wang, Z., Levison, B. S., Koeth, R. A., Britt, E. B., Fu, X. and Wu, Y. and Hazen, S. L. (2013). Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. New England Journal of Medicine 368, 1575-1584.
56 Tang, W. H. W., Wang, Z., Shrestha, K., Borowski, A. G., Wu, Y., Troughton, R. W., Klein, A. and Hazen, S. L. (2015). Intestinal microbiota-dependent phosphatidylcholine metabolites, diastolic dysfunction, and adverse clinical outcomes in chronic systolic heart failure. Journal of cardiac failure 21, 91-96.
57 Thursby, E. and Juge, N. (2017). Introduction to the human gut microbiota. The Biochemical journal 474, 1823-1836.
58 Tomova, A., Bukovsky, I., Rembert, E., Yonas, W., Alwarith, J., Barnard, N. D. and Kahleova, H. (2019). The effects of vegetarian and vegan diets on gut microbiota. Frontiers in Nutrition 6, 47.
59 Ufnal, M. and Nowinski, A. (2019). Is increased plasma TMAO a compensatory response to hydrostatic and osmotic stress in cardiovascular diseases? Medical Hypotheses 130, 109271.
60 Velasquez, M. T., Ramezani, A., Manal, A. and Raj, D. S. (2016). Trimethylamine N-Oxide: The Good, the Bad and the Unknown. Toxins 8, 326.
61 Wang, Z., Klipfell, E., Bennett, B. J., Koeth, R., Levison, B. S., Dugar, B., Feldstein, A. E., Britt, E. B., Fu, X., Chung, Y. M., Wu, Y., Schauer, P., Smith, J. D., Allayee, H., Tang, W. H., DiDonato, J. A., Lusis, A. J. and HazenS., L. (2011). Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature 472, 57-63.
62 Wang, Z., Tang, W. H., Buffa, J. A., Fu, X., Britt, E. B., Koeth, R. A., Levison, B. S., Fan, Y., Wu, Y. and Hazen, S. L. (2014). Prognostic value of choline and betaine depends on intestinal microbiota-generated metabolite trimethylamine- N-oxide. European Heart Journal 35, 904-910.
63 Yin, J., Liao, S. X., He, Y., Wang, S., Xia, G. H., Liu, F. T., Zhu, J. J., You, C., Chen, Q., Zhou, L., Pan, S. Y. and Zhou, H. W. (2015). Dysbiosis of Gut Microbiota With Reduced Trimethylamine-N-Oxide Level in Patients With Large-Artery Atherosclerotic Stroke or Transient Ischemic Attack. JournaloftheAmericanHeartAssociation 4, 1-12.
[1] Adila A Hamid, Amilia Aminuddin, Mohd Heikal Mohd Yunus, Jaya Kumar Murthy, Chua Kien Hui, Azizah Ugusman. Antioxidative and anti-inflammatory activities of Polygonum minus: a review of literature[J]. Reviews in Cardiovascular Medicine, 2020, 21(2): 275-287.
[2] Wenyan Jiang, Mei Wang. New insights into the immunomodulatory role of exosomes in cardiovascular disease[J]. Reviews in Cardiovascular Medicine, 2019, 20(3): 153-160.
[3] Rudaynah A. Alali. A short review of proprotein convertase subtilisin/kexin type 9 inhibitors[J]. Reviews in Cardiovascular Medicine, 2019, 20(1): 1-8.
[4] Jing Jin, Yufeng Liu, Lihong Huang, Hong Tan. Advances in epigenetic regulation of vascular aging[J]. Reviews in Cardiovascular Medicine, 2019, 20(1): 19-25.
[5] Jennifer G. Robinson, Karol E. Watson. Identifying Patients for Nonstatin Therapy[J]. Reviews in Cardiovascular Medicine, 2018, 19(S1): 1-8.
[6] Davide Bolignano, Anna Pisano, Graziella D’Arrigo. Pulmonary hypertension: a neglected risk condition in renal patients?[J]. Reviews in Cardiovascular Medicine, 2018, 19(4): 117-121.
[7] Peter A. McCullough, Aaron Y. Kluger, Kristen M. Tecson, Clay M. Barbin, Andy Y. Lee, Edgar V. Lerma, Zachary P. Rosol, Sivan L. Kluger, Janani Rangaswami. Inhibition of the Sodium–Proton Antiporter (Exchanger) is a Plausible Mechanism of Potential Benefit and Harm for Drugs Designed to Block Sodium Glucose Co-transporter 2[J]. Reviews in Cardiovascular Medicine, 2018, 19(2): 51-63.
[8] Alberto Palazzuoli, Helen Hashemi, Lauren C. Jameson, Peter A. McCullough. Hyperuricemia and Cardiovascular Disease[J]. Reviews in Cardiovascular Medicine, 2017, 18(4): 134-145.
[9] Claudio Ronco, Federico Ronco, Peter A. McCullough. A Call to Action to Develop Integrated Curricula in Cardiorenal Medicine[J]. Reviews in Cardiovascular Medicine, 2017, 18(3): 93-99.
[10] Boback Ziaeian, John Dinkler, Karol Watson. Implementation of the 2013 American College of Cardiology/American Heart Association Blood Cholesterol Guideline Including Data From the Improved Reduction of Outcomes: Vytorin Efficacy International Trial[J]. Reviews in Cardiovascular Medicine, 2015, 16(2): 125-130.
[11] Norman E. Lepor, Dean D. Fouchia, Peter A. McCulloughsup. New Vistas for the Treatment of Obesity: Turning the Tide Against the Leading Cause of Morbidity and Cardiovascular Mortality in the Developed World[J]. Reviews in Cardiovascular Medicine, 2014, 15(S2): 1-21.
[12] Virginia A. Triant. Epidemiology of Coronary Heart Disease in Patients With Human Immunodeficiency Virus[J]. Reviews in Cardiovascular Medicine, 2014, 15(S1): 1-8.
[13] Paolo Gresele, Emanuela Falcinelli, Stefania Momi, Daniela Francisci, Franco Baldelli. Highly Active Antiretroviral Therapy–related Mechanisms of Endothelial and Platelet Function Alterations[J]. Reviews in Cardiovascular Medicine, 2014, 15(S1): 9-20.
[14] Patrick W.G. Mallon. Impact of Nucleoside Reverse Transcriptase Inhibitors on Coronary Heart Disease[J]. Reviews in Cardiovascular Medicine, 2014, 15(S1): 21-29.
[15] Norman E. Lepor, Laurn Contreras, Chirag Desai, Dean J. Kereiakes. The Potential Role of Anti-PCSK9 Monoclonal Antibodies in the Management of Hypercholesterolemia[J]. Reviews in Cardiovascular Medicine, 2014, 15(4): 290-309.
No Suggested Reading articles found!