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Introduction Cardiovascular disease (CVD) is a leading global cause of mortality, primarily driven by atherosclerosis ( Dietary components shape gut microbiome composition and function by providing substrates such as fiber, fat, and protein ( The gut microbiota produces TMA from dietary L-carnitine, choline, phosphatidylcholine, and betaine ( In vitro experiments using colon models have shown that a polyphenol-rich pomegranate extract and the pomegranate polyphenol punicalagin can inhibit microbial TMA production from L-carnitine ( in vivo