The gut-heart axis: a review of the mechanisms and therapeutic prospects of gut microbiota and their metabolites in cardiovascular disease

Abstract

The gut microbiota, a vital virtual organ, communicates bidirectionally with the host cardiovascular system via its intricate metabolic network, forming the gut-heart axis. This review systematically clarifies the causal relationship between gut dysbiosis and the pathogenesis of cardiovascular diseases CVD), moving beyond epidemiological associations to solid causal evidence from preclinical and clinical studies. We focus on dissecting the pathophysiological mechanisms of key microbiota-derived metabolites, including trimethylamine N-oxide, short-chain fatty acids, phenylacetylglutamine, and secondary bile acids, and elaborate on their specific regulatory pathways in the development of atherosclerosis, hypertension, heart failure, and thrombosis. Finally, this review comprehensively evaluates the application potential and clinical challenges of gut microbiota-targeted therapeutic strategies, including dietary interventions, prebiotics/probiotics, fecal microbiota transplantation, and novel pharmacological agents targeting microbial metabolic pathways.