Previous research has identified several metabolites related to gut microbiome [5-7], fatty acid metabolism , inflammation , steroid metabolism , sphingolipids , and phospholipids as biomarkers of CAD . Many of these biomarkers were either not validated or could not be replicated in other cohorts. Most of these studies were also done on collected samples obtained several years ago in dissimilar cohorts. There is therefore an inherent bias in using them either as a derivative or validation cohort. Limited participants or samples in each cohort also sometimes prohibit dividing a cohort into derivative and validation sub cohorts for identifying the true metabolomics signature of CAD. Furthermore, it also remains unclear whether the identified metabolite associated with CAD is causal or just a bystander.