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TMAO reduces bile acid pools, inhibiting FXR activity, disrupting bile acid-FXR signaling, and upregulating pathways worsening hepatic steatosis, as confirmed in HFD-fed C57BL/6J mice and human samples (154)

Lipoprotein apheresis may be considered in patients with very high Lp(a) levels ( 60 mg/dl [ 150 nmol/l]) and progressive ASCVD, despite optimal treatment of other cardiovascular risk factors [100] (Tables VI, VII)