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Intestinal Microbial Metabolism of Phosphatidylcholine and Cardiovascular Risk Published April 25, 2013 N Engl J Med 2013;368:1575-1584 DOI: 10.1056/NEJMoa1109400 Abstract Background Recent studies in animals have shown a mechanistic link between intestinal microbial metabolism of the choline moiety in dietary phosphatidylcholine (lecithin) and coronary artery disease through the production of a proatherosclerotic metabolite, trimethylamine- N -oxide (TMAO)