Recent advances in cardiovascular research increasingly recognize the gut microbiome as a pivotal factor influencing cardiovascular disease (CVD) pathogenesis and treatment outcomes. The intricate interplay between gut microbial communities and host cardiovascular health—the “gut-heart axis”—has become a promising frontier in precision cardiology, opening new avenues for therapeutic intervention and personalized care. A study published in Comprehensive Physiology seeks to understand this link.
Several established cardiovascular drugs exhibit significant effects on gut microbiota composition, which may contribute to their efficacy or side effect profiles. For instance, angiotensin-converting enzyme inhibitors (ACE-Is) like captopril, benazepril, and enalapril not only reduce blood pressure (BP) but also modulate gut bacterial populations. Statins—widely prescribed lipid-lowering agents such as simvastatin, rosuvastatin, and atorvastatin—also alter gut microbial composition, potentially influencing secondary bile acid metabolism and farnesoid X receptor (FXR) signaling pathways linked to cholesterol regulation. Metformin, commonly used in diabetic patients who often have concomitant CVD, increases the abundance of Akkermansia muciniphila, a beneficial bacterium linked to improved metabolic and cardiovascular outcomes.
Beyond pharmacotherapies, fecal microbiota transplantation (FMT) is emerging as a novel intervention aimed at restoring a balanced gut microbiome in patients with dysbiosis-related conditions, including CVD. FMT transfers processed stool from healthy donors to recipients, promoting colonization with beneficial microbes, restoring key metabolites such as short-chain fatty acids (SCFAs), and modulating immune and metabolic pathways.
Postbiotics—nonviable microbial products such as SCFAs, enzymes, and peptides—offer promising cardiovascular benefits with improved safety profiles compared to live microbes. They provide targeted delivery of bioactive compounds that modulate inflammation, oxidative stress, and endothelial function. Furthermore, lifestyle interventions like regular physical activity and dietary modifications, including adoption of fiber-rich Mediterranean diets, complement pharmacological and microbiota-based strategies by naturally promoting gut microbial diversity and function.
Personalized medicine approaches leveraging microbiome profiling could optimize dietary, probiotic, prebiotic, or pharmacological interventions tailored to individual microbial signatures. Pharmacogenomics and pharmacomicrobiomics—studying drug-microbiota interactions—are emerging fields critical to enhancing drug efficacy and minimizing adverse effects.
The gut microbiome’s role in cardiovascular health extends beyond disease risk to influence drug metabolism and therapeutic responses. Integrating microbiome science with cardiology holds great promise for innovative, personalized interventions to reduce systemic inflammation, improve metabolic profiles, and enhance cardiovascular outcomes.
Sources: Comprehensive Physiology