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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2020; 12(4): 110-122
Published online Apr 26, 2020. doi: 10.4330/wjc.v12.i4.110
Role of gut microbiota in cardiovascular diseases
Marko Novakovic, Amit Rout, Thomas Kingsley, Robert Kirchoff, Amteshwar Singh, Vipin Verma, Ravi Kant, Rahul Chaudhary
Marko Novakovic, Amit Rout, Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
Thomas Kingsley, Robert Kirchoff, Rahul Chaudhary, Department of Internal Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
Amteshwar Singh, Department of Internal Medicine, Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
Vipin Verma, Department of Internal Medicine, Medical University of South Carolina/AnMed Campus, Charleston, SC 29425, United States
Ravi Kant, Division of Endocrinology, Diabetes and Nutrition, Medical University of South Carolina/Anmed Campus, Anderson, SC 29621, United States
Author contributions: Kingsley T, Kirchoff R and Chaudhary R proposed study conception and designed the study; Novakovic M, Rout A, Singh A and Verma V acquired the data; Novakovic M, Rout A, Kingsley T, Verma V, Kant R and Chaudhary R analyzed and interpreted the data; Novakovic M, Rout A, Kingsley T, Kirchoff R, Singh A, Kant R and Verma V drafted the manuscript; Singh A, Kant R and Chaudhary R revised the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rahul Chaudhary, MD, FACP, Doctor, Staff Physician, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. chaudhary.rahul@mayo.edu
Received: December 8, 2019
Peer-review started: December 8, 2019
First decision: January 7, 2020
Revised: March 3, 2020
Accepted: March 12, 2020
Article in press: March 12, 2020
Published online: April 26, 2020
Processing time: 135 Days and 16.2 Hours
Abstract

The human gut is colonized by a community of microbiota, primarily bacteria, that exist in a symbiotic relationship with the host. Intestinal microbiota-host interactions play a critical role in the regulation of human physiology. Deleterious changes to the composition of gut microbiota, referred to as gut dysbiosis, has been linked to the development and progression of numerous diseases, including cardiovascular disease (CVD). Imbalances in host-microbial interaction impair homeostatic mechanisms that regulate health and can activate multiple pathways leading to CVD risk factor progression. Most CVD risk factors, including aging, obesity, dietary patterns, and a sedentary lifestyle, have been shown to induce gut dysbiosis. Dysbiosis is associated with intestinal inflammation and reduced integrity of the gut barrier, which in turn increases circulating levels of bacterial structural components and microbial metabolites, including trimethylamine-N-oxide and short-chain fatty acids, that may facilitate the development of CVD. This article reviews the normal function and composition of the gut microbiome, mechanisms leading to the leaky gut syndrome, its mechanistic link to CVD and potential novel therapeutic approaches aimed towards restoring gut microbiome and CVD prevention. As CVD is the leading cause of deaths globally, investigating the gut microbiota as a locus of intervention presents a novel and clinically relevant avenue for future research.

Keywords: Cardiovascular disease; Coronary artery disease; Gut microbiota; Dysbiosis; Thrombosis; Coronary artery disease

Core tip: As cardiovascular diseases (CVD) remain the leading cause of mortality, this article reviews the current literature dysbiosis and its role in CVD progression to present a novel therapeutic avenue. In this paper, we provide a comprehensive review on the composition and development of gut microbiota, its changes (dysbiosis) due to endogenous and exogenous factors and the mechanistic association of dysbiosis with development of CVD. Additionally, we explore the potential therapeutic approaches focused at restoring gut microbiota and their impact on CVD.