Gut Lactobacillus Level Is a Predictive Marker for Coronary Atherosclerotic Lesions Progress and Prognosis in Patients With Acute Coronary Syndrome.

Jing Gao,Yin Liu,Jie Wang,Li-Li Zhao,Yuan Wang,Zhuang Cui,Jing-Xian Wang,Yang Chen,Xu Zhang,Jing Ma,Ting-Ting Yao

doi:10.3389/fcimb.2021.687827

Abstract

BackgroundGut microbiota dysbiosis can contribute to the progression of atherosclerosis. We investigated the association of the gut microbiota and the severity of coronary artery lesions and prognosis of patients with ACS.MethodsIn this case-control study, 402 ACS patients and 100 controls were enrolled from June 2017 to December 2018. The number of bacterial species was determined by real-time PCR. A SYNTAX score was calculated for all ACS patients based on their coronary angiography results.ResultsCompared with the healthy controls, the gut microbial levels in Escherichia coli, Streptococcus, and Enterobacteriaceae were significantly increased in ACS patients, while the Lactobacillus level was significantly decreased. Lactobacillus level was as an independent predictor of disease severity on the coronary angiography [high vs. low SYNTAX score: adjusted odds ratio (aOR) = 0.024, 95% confidence interval (CI): 0.004–0.155] and myocardial necrosis [high vs. low cardiac troponin T (cTNT): aOR = 0.317, 95% CI: 0.099–0.914]. Subsequently, a higher Lactobacillus level was associated with a lower risk of an all-cause death [adjusted hazard ratio (aHR) = 0.239; 95% CI: 0.093–0.617] and major adverse cardiac events (MACE) in ACS patients (aHR = 0.208; 95% CI: 0.081–0.531). After stratifying by the type of ACS, a higher Lactobacillus level was significantly associated with the decreased risks of high SYNTAX score, all-cause death, and MACE in the STEMI subgroup but not in the NSTEMI and UAP subgroups.ConclusionsLower Lactobacillus levels may indicate a higher risk of a more severe coronary atherosclerotic lesions and myocardial necrosis and worse prognosis for patients with ACS, particularly in the STEMI subgroup.

Highlights

Cardiovascular disease (CVD) is one of the leading causes of death globally, and places a large economic burden on healthcare systems worldwide (Liu et al, 2018)
In our previous study (Gao et al, 2020) of patients with acute coronary syndrome (ACS), we found that the levels of Bifidobacterium, Lactobacillus, Escherichia coli, Streptococcus, Helicobacter pylori, and Enterobacteriaceae in the gut microbiota were significantly different between the ACS patients and healthy controls
The increase in the Lactobacillus level resulted in a significant increase in the area under the curve (AUC) for the prediction of severe coronary atherosclerotic lesions, and Lactobacillus level was negatively associated with higher major adverse cardiac events (MACE) and all-cause mortality rates after percutaneous coronary intervention (PCI)

Summary

Introduction

Cardiovascular disease (CVD) is one of the leading causes of death globally, and places a large economic burden on healthcare systems worldwide (Liu et al, 2018). An imbalance of the gut microecology leads to a disorder of the flora which can interfere with the basic metabolic processes of the host and lead to the development of CVD such as coronary artery disease (CAD), hypertension, and heart failure (Tang et al, 2015; Senthong et al, 2016b; Li J. et al, 2017; Santisteban et al, 2017). The anatomical SYNTAX score has been shown to predict the occurrence of major adverse cardiac events (MACE) and the long-term prognosis of stable patients with CAD who have undergone coronary revascularization (Serruys et al, 2009; Mohr et al, 2013).

Methods

Results

Conclusion