The Gut–Heart Axis: A Comprehensive Review of Microbiota’s Role in Cardiovascular Health and Disease and Emerging Therapeutic Strategies

This review examines the bidirectional relationship between the gut microbiota and cardiovascular diseases (CVDs), aiming to understand how microbial dysbiosis contributes to CVDs, including atherosclerosis, hypertension, and heart failure. Recent research emphasizes the gut microbiota's role in modulating immunity via SCFAs and tryptophan metabolites, maintaining intestinal barrier integrity, and producing metabolites such as SCFAs (acetate, propionate, butyrate) and pro-atherogenic TMAO. Dietary patterns, particularly the Mediterranean versus Western diet, significantly influence gut microbiota composition and CVD risk. Polyphenols and exercise have shown positive effects on gut microbiota and cardiovascular outcomes. A significant interplay exists between gut microbiota and cardiovascular health. Dysbiosis and metabolites like TMAO and LPS are implicated in CVD, while SCFAs and a balanced microbiota offer protection. Future research should focus on precision medicine, next-gen probiotics, optimized FMT, and multiomics approaches to identify personalized CVD therapies.