Cardiovascular diseases (CVD) & Gut microbiota

Key pathways include Trimethylamine-N-Oxide (TMAO), Short-chain fatty acids (SCFAs), and bile acid metabolism affecting blood pressure, artery health, and heart failure.
Zhang et al. 2025b Front Microbiol 16: 1690411

The gut microbiota has been linked to cardiovascular diseases (CVD) such as heart failure , atherosclerosis, hypertension, myocardial fibrosis, and myocardial infarction
Tang et al. 2017 Circ Res. 120(7): 1183-1196
Novakovic et al. 2020 World J Cardiol 12(4): 110-122
Rahman et al. 2022 Front. Cell. Infect. Microbiol. 12: 903570

The role of gut microbiota in cardiovascular disease is concisely described in Zhou's publication, which discusses the positive or negative effects of gut microbiota on Cardiovascular diseases (CVD)
Zhou et al. 2020i

Changes in the gut microbiota of individuals with coronary artery disease, hypertension and heart failure have been observed in both human and animal experiments, but the specific mechanisms are still under study
Jin et al. 2019a

Microbial pathways involved

According to a metagenome-based association study a total of 48 bacterial metabolic pathways are associated to metabolic risk of cardiovascular disease, with most involved in metabolism of amino acids, carbohydrates, and polysaccharides
Kurilshikov et al. 2019 Circ Res 124: 1808-20

Flavonoid, gamma-butyrobetaine, and cholesterol metabolism are among microbial pathways involved in cardiovascular disease. Species from the genus Oscillibacter have been associated with reduced stool and plasma cholesterol levels.
Li et al. 2024b Cell 187(8): 1834-1852

Oscillibacter species have cholesterol metabolizing capabilities, including glycosylation and dehydration. These are likely to be potential benefits for lipid homeostasis and cardiovascular health.
Li et al. 2024b Cell 187(8): 1834-1852

Role of Pattern Recognition Receptors (PRRs)

Among all of the Cardiovascular Diseases (CVD) -associated Microbial associated molecular patterns (MAMPs) - Pattern Recognition Receptors (PRRs) pathways, the lipopolysaccharide (LPS) receptor, Toll-Like Receptor 4 (TLR-4) , has been most thoroughly investigated.
Michelsen et al. 2004 Proc. Natl. Acad. Sci. USA 101: 10679-10684
Ballistreri et al. 2009 J. Clin. Immunol. 29: 406-415
Stewart et al. 2010 Nat. Immunol. 11: 155-161
Kanellakis et al. 2011 Arterioscler. Thromb. Vasc. Biol. 31: 313-319
Ding et al. 2012 Arterioscler. Thromb. Vasc. Biol. 32: 1596-1604

Genetic deficiency of Toll-Like Receptor 4 (TLR-4) in either LDLr −/− or apoE −/− mice is reported to reduce atherosclerotic burden.
Michelsen et al. 2004 Proc. Natl. Acad. Sci. USA 101: 10679-10684
Stewart et al. 2010 Nat. Immunol. 11: 155-161
Ding et al. 2012 Arterioscler. Thromb. Vasc. Biol. 32: 1596-1604

Causes

Dysbiosis

see Cardiovascular diseases (CVD) & Dysbiosis

Microbial metabolites

The gut microbiota can affect cardiovascular health through the production of metabolites like trimethylamine N-oxide (TMAO) and short-chain fatty acids
Brown & Hazen 2018 Nat. Rev. Microbiol. 16: 171-181
Murphy et al. 2021 Metabolites 11: 493
Masenga et al. 2022 J Hum Hypertens 36: 952-959
Rahman et al. 2022 Front. Cell. Infect. Microbiol. 12: 903570

For instance, gut microbiota can utilize trimethylamine, N-oxide / Amine oxide, short-chain fatty acids, and primary and secondary bile acid pathways, affecting living cells and potentially causing Cardiovascular diseases (CVD)
Brown & Hazen 2018 Nat. Rev. Microbiol. 16: 171-181
Murphy et al. 2021 Metabolites 11: 493
Rahman et al. 2022 Front. Cell. Infect. Microbiol. 12: 903570

Pathogens

For example, heart failure associated with splanchnic circulation congestion, bowel wall edema, and impaired intestinal barrier function can result in Bacterial Translocation / Intestinal permeability, leading to the presence of bacterial products in the systemic circulation and a heightened inflammatory state. These factors are believed to contribute to the further progression of heart failure and atherosclerosis
Tang et al. 2017 Circ Res. 120(7): 1183-1196

Chronic infection with pathogenic bacteria has been associated with the progression of Cardiovascular Diseases (CVD)
Saikku et al. 1992 Ann. Intern. Med. 15: 273-278
Kol et al. 1999 J. Clin. Invest. 103: 571-577
Chen et al. 2008 J. Immunol. 181: 7186-7193
Koren et al. 2011 Proc. Natl. Acad. Sci. USA. 108(Suppl. 1): 4592-4598
Karlsson et al. 2012 Nat Commun 3: 1245
Caladrini et al. 2014 Oral Dis. 20: e128-e134
Filardo et al. 2015 Mediators Inflamm. 2015: 37865
Kholy et al. 2015 Trends Endocrinol. Metab. 26: 315-321
Mitra et al. 2015 Microbiome. 3: 38

Stress

The gut microbiota is an important source of neuroimmune mediators in the pathogenesis of Cardiovascular Diseases (CVD)
Suslov et al. 2021 J Clin Med 10: 1995

Stress associated with Cardiovascular Diseases (CVD) affects the whole organism, including the gastrointestinal tract , by activating the sympathetic division of the [Autonomic Nervous System (ANS)] . Under the influence of Autonomic Nervous System (ANS), the decreased blood supply to the intestines with the inhabited microbiota reduces the activity of the digestive glands, and intestinal peristalsis in the gastrointestinal tract slows down
Browning et al. 2014 In Comprehensive Physiology, Terjung, R., Ed. Wiley: Hoboken, NJ, USA, 1339-1368

Food / Diets / Nutrients

see Food / Diets / Nutrients & Gut microbiota

Therapeutic intervention

The use of pre- and probiotics and TMAO inhibitors, have been suggested as potential strategies for managing Cardiovascular diseases (CVD)
Novakovic et al. 2020 World J Cardiol 12(4): 110-122
Masenga et al. 2022 J Hum Hypertens 36: 952-959

The currently proposed therapeutic interventions are targeted towards the restoration of the gut microbiota , including dietary modifications
Novakovic et al. 2020 World J Cardiol 12(4): 110-122

Fecal microbial community changes have also been associated with Cardiovascular diseases (CVD)
Witkowski et al. 2020 Circulation Research 127: 553-570

In one study, a blood pressure-lowering effect was observed in a patient with treatment-resistant hypertension when treated with a combination of antibiotics
Tang et al. 2017 Circ Res. 120(7): 1183-1196

see also:
Atherosclerosis / Coronary Artery Disease (CAD) / Coronary Heart Disease (CHD) / Ischemic Heart Disease (IHD) & Dysbiosis
Cardiovascular Diseases (CVD) & Dietary fibers (DF)
Cardiovascular diseases (CVD) & Dysbiosis
Cardiovascular Diseases (CVD) & Phenylacetylglutamine (PAG)
Cardiovascular Diseases (CVD) & Short-Chain Fatty Acids (SCFAs)
Fecal Microbiota Transplantation (FMT) & Cardiovascular Diseases (CVD)
Gut microbiota & Heart Failure / Congestive Heart Failure (CHF)
Gut microbiota & Metabolic activities / Metabolism
Prebiotics & Cardiovascular Diseases (CVD)