To date, these important noninsulin glucose-lowering therapies have only received regulatory approval for use in T2D, obesity, sleep apnea, and metabolic dysfunction-associated steatohepatitis with moderate-advanced fibrosis, supported by randomized controlled trials (RCTs) and real-world data that demonstrate efficacy and safety
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Instead, collectively, our analyses suggest that in non-interventional settings where most individuals consume meat daily (75233 g/day for European adults 37 ), clearance by the kidney and not dietary intake of TMAO precursors is the major determinant of fasting circulating TMAO levels and therefore of the excess cardiovascular risk associated with elevated TMAO (vegetarians and strict vegans aside, who are infrequent in the MetaCardis cohort with only 65/1741 participants reporting no red meat consumption)
Still, challenges remain, which include relatively high discontinuation rates that appear to be the result of adverse side effects, as well as questions pertaining to pricing and insurance coverage once the product is approved by the Food and Drug Administration
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