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Trimethylamine-N-oxide (TMO) is one of the best studied metabolites of the gut microbiota. It increases the risk of stroke and dyscirculatory encephalopathy, independent of traditional cardiovascular risk factors. The mechanisms of the negative effects of TMO on the cardiovascular system are related to the acceleration of atherosclerosis progression, platelet activation, and the development of aseptic inflammation. Currently, elevated TMO levels are an indication for a strict diet with restriction of foods rich in TMO precursors. Future research should clarify the role of TMO in the development of cerebrovascular disease (CVD). It is necessary to continue the investigation of new compounds that can reduce TMO levels in patients at high risk for developing CVD.