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In this editorial, Prof. Thomas F. Lüscher comments on the original article Trimethylamine N-oxide is associated with long-term mortality risk: the Multi-Ethnic Study of Atherosclerosis, by M. Wang et al., in which the authors show that plasma TMAO levels (a gut microbiota-generated metabolite) associate with cardiovascular and renal mortality in a multi-ethnic US cohort. Check out the full article, now available in the latest issue of the European Heart Journal.