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A separate ~10,000-patient cardiovascular outcomes trial (TRIUMPH-Outcomes) won't report until 20282029

Contributing factors include: reduced nutritional intake (proteins, essential amino acids, competition between amino acid transporters, vitamin insufficiency [riboflavin: GSSG reductase, nicotinic acid: NADPH, pyridoxine (B 6 ): SAMe pathway], mitochondrial dysfunction: ATP deficiency, down regulation SAMe synthase, oxidation of SAMe pathway enzymes, enhanced GSH utilization: conjugation reactions (toxins, drugs), and overwhelming oxidative challenge

Isogai, T., Matsui, H., Tanaka, H., Fushimi, K

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