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Moreover, studies consistently demonstrate that individuals with advanced fibrosis have a significantly higher likelihood of adverse cardiovascular outcomes, including myocardial infarction, stroke, and heart failure, compared with those with minimal or no fibrosis [38-41]

Two downstream consequences are mechanistically central: nicotinamide is preserved for re-entry into the NAD+ salvage pathway (raising intracellular NAD+ availability), and SAM is preserved for other methylation reactions

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