GUT MICROBIOTA IN CARDIOVASCULAR DISEASES. FROM MECHANISTIC INSIGHTS TO THERAPEUTIC PERSPECTIVES

Authors

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.5403

Keywords:

Gut Microbiota, Cardiovascular Diseases, Short-Chain Fatty Acids (SCFAs), Trimethylamine N-oxide (TMAO), Atherosclerosis, Arterial Hypertension, Probiotics, Prebiotics, Synbiotics, Multi-Omics

Abstract

Cardiovascular diseases remain the leading cause of death worldwide, prompting continuous efforts to understand and treat their pathogenesis. In recent years, increasing attention has been paid to the role of the gut microbiome as a potential factor influencing the functioning of the cardiovascular system. The gut microbiota produces numerous bioactive metabolites, such as short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO), which affect lipid metabolism, modulate systemic inflammation, and regulate blood pressure. SCFAs exhibit anti-inflammatory properties, whereas TMAO is associated with an increased risk of cardiovascular events.

Gut dysbiosis, defined as an imbalance in the intestinal microbiome, promotes chronic inflammation, increased intestinal barrier permeability, and activation of mechanisms that contribute to the development of atherosclerosis. This paper discusses the role of the gut microbiome in the pathogenesis of selected cardiovascular diseases, such as atherosclerosis, arterial hypertension, heart failure, and cardiac arrhythmias. Findings from observational and cohort studies reported in numerous scientific publications indicate characteristic alterations in the gut microbiota of patients with these conditions, although these relationships are primarily associative in nature.

The paper also presents potential strategies for modulating the gut microbiota through the use of a properly balanced diet, as well as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT). Despite the growing body of evidence supporting a strong link between alterations in the gut microbiota and the development of cardiovascular diseases, there are still limitations in therapeutic approaches, including the lack of standardized research methods, high interindividual variability in microbiota composition, and a limited number of causal studies.

Future research directions should therefore include the development of personalized medicine, the application of multi-omics techniques, and the use of postbiotics. A better understanding of the interactions between the gut microbiota and the development and progression of cardiovascular diseases may contribute to the development of more effective treatment strategies.

References

Brown, J. M., & Hazen, S. L. (2018). Microbial modulation of cardiovascular disease. Nature Reviews Microbiology, 16(3), 171–181. https://doi.org/10.1038/nrmicro.2017.149

Hao, W. L., & Lee, Y. K. (2004). Microflora of the gastrointestinal tract: A review. Methods in Molecular Biology, 268, 491–502. https://doi.org/10.1385/1-59259-766-1:491

Org, E., Mehrabian, M., Parks, B. W., Shipkova, P., Liu, X., Drake, T. A., & Lusis, A. J. (2016). Sex differences and hormonal effects on gut microbiota composition in mice. Gut Microbes, 7(4), 313–322. https://doi.org/10.1080/19490976.2016.1203502

Adak, A., & Khan, M. R. (2019). An insight into gut microbiota and its functionalities. Cellular and Molecular Life Sciences, 76(3), 473–493. https://doi.org/10.1007/s00018-018-2943-4

Marques, F. Z., Nelson, E., Chu, P. Y., Horlock, D., Fiedler, A., Ziemann, M., ... Mackay, C. R. (2017). High-fiber diet and acetate supplementation change the gut microbiota and prevent the development of hypertension and heart failure in hypertensive mice. Circulation, 135(10), 964–977. https://doi.org/10.1161/CIRCULATIONAHA.116.024545

Robles-Vera, I., Toral, M., de la Visitación, N., Sánchez, M., Gómez-Guzmán, M., Romero, M., ... Duarte, J. (2018). Probiotics prevent dysbiosis and the rise in blood pressure in genetic hypertension: Role of short-chain fatty acids. Molecular Nutrition & Food Research, 62(6), 1700616. https://doi.org/10.1002/mnfr.201700616

Sandek, A., Bauditz, J., Swidsinski, A., Buhner, S., Weber-Eibel, J., von Haehling, S., ... Doehner, W. (2007). Altered intestinal function in patients with chronic heart failure. Journal of the American College of Cardiology, 50(16), 1561–1569. https://doi.org/10.1016/j.jacc.2007.07.016

Mo, R., Zhang, X., & Yang, Y. (2021). Effect of probiotics on lipid profiles and blood pressure in patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. Medicine, 100(9), e24805. https://doi.org/10.1097/MD.0000000000024805

de la Cuesta-Zuluaga, J., Mueller, N. T., Corrales-Agudelo, V., Velásquez-Mejía, E. P., Carmona, J. A., Abad, J. M., & Escobar, J. S. (2017). Metformin is associated with higher relative abundance of mucin-degrading Akkermansia muciniphila and several short-chain fatty acid-producing microbiota in the gut. Diabetes Care, 40(1), 54–62. https://doi.org/10.2337/dc16-1324

Toral, M., Robles-Vera, I., de la Visitación, N., Romero, M., Yang, T., Sánchez, M., ... Duarte, J. (2019). Critical role of the interaction gut microbiota-sympathetic nervous system in the regulation of blood pressure. Frontiers in Physiology, 10, 231. https://doi.org/10.3389/fphys.2019.00231

Fennema, D., Phillips, I. R., & Shephard, E. A. (2016). Trimethylamine and trimethylamine N-oxide, a flavin-containing monooxygenase 3 (FMO3)-mediated host-microbiome metabolic axis implicated in health and disease. Drug Metabolism and Disposition, 44(11), 1839–1850. https://doi.org/10.1124/dmd.116.070615

Koeth, R. A., Wang, Z., Levison, B. S., Buffa, J. A., Org, E., Sheehy, B. T., ... Hazen, S. L. (2013). Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine, 19(5), 576–585. https://doi.org/10.1038/nm.3145

Heianza, Y., Ma, W., Manson, J. E., Rexrode, K. M., & Qi, L. (2017). Gut microbiota metabolites and risk of major adverse cardiovascular disease events and death: A systematic review and meta-analysis of prospective studies. Journal of the American Heart Association, 6(7), e004947. https://doi.org/10.1161/JAHA.116.004947

Zhu, W., Gregory, J. C., Org, E., Buffa, J. A., Gupta, N., Wang, Z., ... Hazen, S. L. (2016). Gut microbial metabolite TMAO enhances platelet hyperreactivity and thrombosis risk. Cell, 165(1), 111–124. https://doi.org/10.1016/j.cell.2016.02.011

Jonsson, A. L., & Bäckhed, F. (2017). Role of gut microbiota in atherosclerosis. Nature Reviews Cardiology, 14(2), 79–87. https://doi.org/10.1038/nrcardio.2016.183

Kim, S., Goel, R., Kumar, A., Qi, Y., Lobaton, G., Hosaka, K., ... Sabet, M. (2018). Imbalance of gut microbiome and intestinal epithelial barrier dysfunction in patients with high blood pressure. Clinical Science, 132(6), 701–718. https://doi.org/10.1042/CS20180087

Tang, W. H. W., Kitai, T., & Hazen, S. L. (2017). Gut microbiota in cardiovascular health and disease. Circulation Research, 120(7), 1183–1196. https://doi.org/10.1161/CIRCRESAHA.117.309715

Jie, Z., Xia, H., Zhong, S. L., Feng, Q., Li, S., Liang, S., ... Kristiansen, K. (2017). The gut microbiome in atherosclerotic cardiovascular disease. Nature Communications, 8(1), 845. https://doi.org/10.1038/s41467-017-00900-1

Liu, H., Chen, X., Hu, X., Niu, H., Tian, R., Wang, H., ... Shi, P. (2019). Alterations in the gut microbiome and metabolism with coronary artery disease severity. Microbiome, 7(1), 68. https://doi.org/10.1186/s40168-019-0683-9

Emoto, T., Yamashita, T., Kobayashi, T., Sasaki, N., Hirota, Y., Hayashi, T., ... Hirata, K. I. (2017). Characterization of gut microbiota profiles in coronary artery disease patients using data mining analysis of terminal restriction fragment length polymorphism. Heart and Vessels, 32(1), 39–46.

Malik, M., Suboc, T. M., Tyagi, S., Salzman, N., Wang, J., Ying, R., ... Widlansky, M. E. (2018). Lactobacillus plantarum 299v supplementation improves vascular endothelial function and reduces inflammatory biomarkers in men with stable coronary artery disease. Circulation Research, 123(9), 1091–1102. https://doi.org/10.1161/CIRCRESAHA.118.313565

Wang, L., Zhou, W., Guo, M., Hua, Y., Zhou, B., Li, X., Zhang, X., Dong, J., Yang, X., Wang, Y., Wu, Y., She, J., & Mu, J. (2021). The gut microbiota is associated with clinical response to statin treatment in patients with coronary artery disease. Atherosclerosis, 325, 16–23. https://doi.org/10.1016/j.atherosclerosis.2021.03.007

Budoff, M. J., de Oliveira Otto, M. C., Li, X. S., Lee, Y., Wang, M., Lai, H. T. M., Lemaitre, R. N., Pratt, A., Tang, W. H. W., Psaty, B. M., Siscovick, D. S., Hazen, S. L., & Mozaffarian, D. (2025). Trimethylamine-N-oxide (TMAO) and risk of incident cardiovascular events in the Multi-Ethnic Study of Atherosclerosis. Scientific Reports, 15(1), 23362. https://doi.org/10.1038/s41598-025-05903-3

Lv, J., Wang, J., Yu, Y., Zhao, M., Yang, W., Liu, J., Zhao, Y., Yang, Y., Wang, G., Guo, L., & Zhao, H. (2023). Alterations of gut microbiota are associated with blood pressure: A cross-sectional clinical trial in Northwestern China. Journal of Translational Medicine, 21, Article 429. https://doi.org/10.1186/s12967-023-04176-6

Yan, Q., Gu, Y., Li, X., Yang, W., Jia, L., Chen, C., Han, X., Huang, Y., Zhao, L., Li, P., Fang, Z., Zhou, J., Guan, X., Ding, Y., Wang, S., Khan, M., Xin, Y., Li, S., & Ma, Y. (2017). Alterations of the gut microbiome in hypertension. Frontiers in Cellular and Infection Microbiology, 7, Article 381. https://doi.org/10.3389/fcimb.2017.00381

Awoyemi, A., Mayerhofer, C., Felix, A. S., Hov, J. R., Moscavitch, S. D., Lappegård, K. T., Hovland, A., Halvorsen, S., Halvorsen, B., Gregersen, I., Solheim, S., & Broch, K. (2021). Rifaximin or Saccharomyces boulardii in heart failure with reduced ejection fraction: Results from the randomized GutHeart trial. EBioMedicine, 70, 103511. https://doi.org/10.1016/j.ebiom.2021.103511

Ma, J., Li, H., Li, J., & Jin, L. (2021). The role of gut microbiota in atherosclerosis and hypertension. Frontiers in Pharmacology, 12, 739847. https://doi.org/10.3389/fphar.2021.739847

Palmu, J., Börschel, C. S., Ortega-Alonso, A., Markó, L., Inouye, M., Jousilahti, P., ... et al. (2023). Gut microbiome and atrial fibrillation—Results from a large population-based study. EBioMedicine, 91, 104583. https://doi.org/10.1016/j.ebiom.2023.104583

Wang, Y., He, Y., Li, R., Jiang, H., Tao, D., Zhao, K., et al. (2023). Gut microbiota in patients with postoperative atrial fibrillation undergoing off-pump coronary bypass graft surgery. Journal of Clinical Medicine, 12(4), 1493. https://doi.org/10.3390/jcm12041493

Hill, C., Guarner, F., Reid, G., Gibson, G. R., Merenstein, D. J., Pot, B., ... Sanders, M. E. (2014). Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews Gastroenterology & Hepatology, 11(8), 506–514. https://doi.org/10.1038/nrgastro.2014.66

Daliri, E. B. M., & Lee, B. H. (2018). New perspectives on probiotics in health and disease. Food Science and Human Wellness, 7(4), 259–270. https://doi.org/10.1016/j.fshw.2018.09.001

Gibson, G. R., Hutkins, R., Sanders, M. E., Prescott, S. L., Reimer, R. A., Salminen, S. J., ... Reid, G. (2017). Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nature Reviews Gastroenterology & Hepatology, 14(8), 491–502. https://doi.org/10.1038/nrgastro.2017.75

Vrieze, A., Van Nood, E., Holleman, F., Salojärvi, J., Kootte, R. S., Bartelsman, J. F., ... Nieuwdorp, M. (2012). Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology, 143(4), 913–916.e7. https://doi.org/10.1053/j.gastro.2012.06.031

Li, J., Zhao, F., Wang, Y., Chen, J., Tao, J., Tian, G., ... Li, Y. (2017). Gut microbiota dysbiosis contributes to the development of hypertension. Microbiome, 5(1), 14. https://doi.org/10.1186/s40168-016-0222-x

DeFilipp, Z., Bloom, P. P., Torres Soto, M., Mansour, M. K., Sater, M. R. A., Huntley, M. H., ... Hohmann, E. L. (2019). Drug-resistant E. coli bacteremia transmitted by fecal microbiota transplant. New England Journal of Medicine, 381(21), 2043–2050. https://doi.org/10.1056/NEJMoa1910437

Pasini, E., Aquilani, R., Testa, C., Baiardi, P., Angioletti, S., Boschi, F., ... Dioguardi, F. S. (2016). Pathogenic gut flora in patients with chronic heart failure. JACC: Heart Failure, 4(3), 220–227. https://doi.org/10.1016/j.jchf.2015.10.009

Zmora, N., Suez, J., & Elinav, E. (2019). You are what you eat: Diet, health and the gut microbiota. Nature Reviews Gastroenterology & Hepatology, 16(1), 35–56. https://doi.org/10.1038/s41575-018-0061-2

Lau, K., Srivatsav, V., Rizwan, A., Nashed, A., Liu, R., Shen, R., & Akhtar, M. (2017). Bridging the gap between gut microbial dysbiosis and cardiovascular diseases. Nutrients, 9(8), 859. https://doi.org/10.3390/nu9080859

Knight, R., Vrbanac, A., Taylor, B. C., Aksenov, A., Callewaert, C., Debelius, J., ... Dorrestein, P. C. (2018). Best practices for analysing microbiomes. Nature Reviews Microbiology, 16(7), 410–422. https://doi.org/10.1038/s41579-018-0029-9

Rajilic-Stojanovic, M., & de Vos, W. M. (2014). The first 1000 cultured species of the human gastrointestinal microbiota. FEMS Microbiology Reviews, 38(5), 996–1047. https://doi.org/10.1111/1574-6976.12075

Agus, A., Clément, K., & Sokol, H. (2021). Gut microbiota-derived metabolites as central regulators in metabolic disorders. Gut, 70(6), 1174–1182. https://doi.org/10.1136/gutjnl-2020-323071

Integrative HMP (iHMP) Research Network Consortium. (2019). The integrative human microbiome project. Nature, 569(7758), 641–648. https://doi.org/10.1038/s41586-019-1238-8

Downloads

Published

2026-03-30

How to Cite

Majda, A., Sitko , N., Makowska , P., Gontarczyk , J., Laske , A. ., Sowa, M. ., Pająk , J., Kucharski , K. ., Kamosińska , A. ., Kowal, A., Sokołowska , J., & Dawidowicz, M. (2026). GUT MICROBIOTA IN CARDIOVASCULAR DISEASES. FROM MECHANISTIC INSIGHTS TO THERAPEUTIC PERSPECTIVES. International Journal of Innovative Technologies in Social Science, 4(1(49). https://doi.org/10.31435/ijitss.1(49).2026.5403

Most read articles by the same author(s)