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In many diabetes cardiovascular outcome trials, average weight loss was relatively modest, yet the reduction in cardiovascular events was meaningful, suggesting additional biology at play beyond lighter body, healthier heart. 2) The timeline doesnt always match weight loss explains it all. Weight loss is a gradual process, but cardiovascular risk reduction can begin earlier than youd expect if weight loss were the only driver

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Circulating concentrations of choline and betaine and risk of cardiovascular disease A 1995 study had found that elevated blood homocysteine concentrations in patients who experienced a vascular occlusion were associated with higher urinary excretion of betaine, rather than with reduced intake of choline or betaine or diminished activity of BHMT (49)