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Common causes include: Pernicious anaemia Malabsorption disorders (e.g., coeliac disease, Crohns) Chronic alcohol abuse Long-term use of antacids or metformin Vegan or vegetarian diet without supplementation 3

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The nitric oxide generated through this pathway promotes vasodilation, inhibits platelet aggregation, and enhances endothelial cell survival while supporting the formation of patent, functional vessels

doi:10.1016/j.ahj.2015.09.013 Davidson KW, Alcantara C, Miller GE