The gut microbiome and cardiovascular disease: current knowledge and clinical potential.

Adilah F Ahmad,Natalie C Ward,Jose Caparros-Martin,Fergal O’Gara,Girish Dwivedi

doi:10.1152/ajpheart.00376.2019

Abstract

Cardiovascular disease (CVD) is the leading cause of death worldwide. The human body is populated by a diverse community of microbes, dominated by bacteria, but also including viruses and fungi. The largest and most complex of these communities is located in the gastrointestinal system and, with its associated genome, is known as the gut microbiome. Gut microbiome perturbations and related dysbiosis have been implicated in the progression and pathogenesis of CVD, including atherosclerosis, hypertension, and heart failure. Although there have been advances in the characterization and analysis of the gut microbiota and associated bacterial metabolites, the exact mechanisms through which they exert their action are not well understood. This review will focus on the role of the gut microbiome and associated functional components in the development and progression of atherosclerosis. Potential treatments to alter the gut microbiome to prevent or treat atherosclerosis and CVD are also discussed.

Highlights

Cardiovascular disease (CVD) is the leading cause of death and disability globally [60]
Overgrowth of Prevotella/Klebsiella in prehypertension, and hypertension compared with controls
Aggregatibacter actinomycetemcomitans, levels linked with risk for Coronary artery disease (CAD)

Summary

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death and disability globally [60]. Recent reviews have highlighted the potential role of dysbiosis in several disease states, including atherosclerosis, heart failure, hypertension, and diabetes mellitus [3, 145] In these states, the gut bacteria diversity, composition, and associated metabolic functions can change, leading to disruption of vital physiological processes, including inflammation, lipid metabolism, bacterial translocation, and glucose homeostasis, which may all contribute to disease development and progression. A recent metagenome-wide association study from 218 individuals with atherosclerosis and 187 healthy controls observed that the gut microbiome deviates from a healthy status by an increase in the relative abundance of enterobacteriaceae (including Escherichia coli, Enterobacter aerogenes, and Klebsiella spp.) and Streptococcus spp (Table 1) This impacts metabolism and transport of molecules such as TMAO [64]. No of Subjects n ϭ 1,046 n ϭ 218 CVD, n ϭ 187 controls n ϭ 56 prehypertensive, n ϭ 99 hypertensive, n ϭ 41 controls n ϭ 179 CAD, n ϭ 166 ACS, n ϭ 119 controls n ϭ symptomatic atherosclerosis, n ϭ controls n ϭ 15 CVD, n ϭ 15 controls

Main Findings

CONCLUSION

DISCLOSURES