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This association with increased risk of CVD with higher TMAO levels was reduced but not eliminated when the authors adjusted their data for other known CVD risk factors, thus establishing higher TMAO levels as an independent risk factor for heart attacks and strokes (1)

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Precipitating factors of HE include gastrointestinal bleeding, infection, constipation, infection, excessive intake of protein, dehydration, renal function disorder, electrolyte imbalance, psychoactive medication, and acute hepatic injury