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High TMAO levels in CKD patients have been associated with increased mortality and adverse cardiovascular outcomes, suggesting that TMAO could be a critical factor in the progression of CKD and its complications [72,73]

Turner, N

9 Psychological stress can be a trigger, including anxiety from fear of the next attack

Carnitine may also regulate Bax/Bcl-2 signaling [132], AMPK/PGC1 signaling [133], MAPK signaling [134, 135], PI3K/Akt signaling [136] and other signaling pathways to play a protective role in the heart