Gut microbiota‑derived metabolites in cardiovascular disease: Focus on trimethylamine N‑oxide, short‑chain fatty acids and bile acids (Review)

The gut‑heart axis, where microbial metabolites act as key signaling molecules, represents a notable frontier in cardiovascular medicine. An expanding body of evidence has demonstrated that gut microbiota‑derived metabolites, particularly trimethylamine N‑oxide (TMAO), short‑chain fatty acids (SCFAs) and bile acids (BAs), play divergent roles in the pathogenesis of cardiovascular diseases. While elevated TMAO levels are consistently linked to pro‑atherogenic and pro‑thrombotic outcomes, SCFAs generally confer vasoprotective and anti‑inflammatory benefits. BAs exhibit dual functions, regulating both lipid metabolism and inflammatory signaling through dedicated receptors. The dynamic balance among these metabolites, which is markedly influenced by diet and microbial composition, collectively shapes cardiovascular risk. The present review critically synthesized the current mechanistic evidence on how TMAO, SCFAs and BAs contribute to hypertension, atherosclerosis and heart failure, with the aim to provide a cohesive framework for the development of novel diagnostic and therapeutic strategies.