choline and l-carnitine TMAO biosynthesis. are derived from the diet Effects of choline metabolite—trimethylamine N-oxide

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This increase in ECM proteins fibrosis separates the individual bundles of muscle cells and disturbs the impulse propagation that causes the heart to beat regularly.[ref] Animal studies from about a decade ago show a pressure overload in the heart (stressing out the heart) can cause mast cells to proliferate

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However, this is controversial and not fully conclusive