High levels of plasma TMAO have been linked to an alteration of reverse cholesterol transport [16,24], hyperlipidemia and hyperglycemia [16,24,25], and the overexpression of inflammatory markers including tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), c-reactive protein (CRP) [26,27], and insulin resistance [16,25], which all lead to the promotion of atherosclerosis [16,19,25,28,29]. Here, TNF is linked to atherosclerosis.