Cardiovascular Health, Gut Microbiome, and Nutrition: A 2025 Review

Recent studies reveal a strong connection between gut health and cardiovascular function, known as the gut-heart axis. Microbial metabolites like TMAO, which promotes atherosclerosis, and SCFAs, which reduce inflammation, play pivotal roles. Diet significantly influences this axis—Mediterranean and DASH diets are shown to lower TMAO levels and blood pressure, while ultra-processed foods worsen gut integrity and promote inflammation. Novel findings highlight the cholesterol-metabolizing potential of Oscillibacter bacteria, suggesting protective effects against cardiovascular disease. However, high salt intake may amplify harmful TMAO production. Emerging interventions such as phage therapy, fecal microbiota transplantation (FMT), and AI-tailored diets offer new hope for restoring microbial balance. Looking ahead, AI-driven microbiome analysis and research into global dietary patterns are set to redefine cardiovascular disease prevention.

Key Takeaways for Readers:

1. Gut-Heart Axis: Emerging research confirms gut microbes directly influence heart health via metabolites like TMAO (linked to atherosclerosis) and SCFAs (anti-inflammatory).
2. Dietary Impact:
   • Mediterranean/DASH diets lower TMAO and blood pressure.
   • Ultra-processed foods worsen gut permeability and inflammation.
3. New Discoveries:
   • Oscillibacter bacteria metabolize cholesterol, reducing CVD risk.
   • High salt intake exacerbates TMAO production.
4. Interventions:
   • Phage therapy and FMT show promise for reversing dysbiosis.
   • Personalized diets (via AI) optimize microbial responses.
5. Future Focus: AI-driven microbiome analysis and global studies on dietary disparities.

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Introduction

Cardiovascular diseases (CVDs) remain the leading global cause of death, with the gut microbiome emerging as a critical modulator of heart health. This underscores the critical role of gut health in preventing and treating CVDs. This review synthesizes 2024–2025 research on microbial metabolites, dietary strategies, and clinical innovations to combat CVD. Gut dysbiosis – an imbalance in the gut microbiota – as a significant factor in the development of CVDs. This complex relationship between gut microbiota and cardiovascular health involves various mechanisms, including the production of metabolites such as trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs). These metabolites influence lipid metabolism, inflammation, and blood pressure regulation. In addition, the gut-brain axis and neurohormonal pathways play crucial roles in cardiovascular function. Epidemiological studies have linked gut dysbiosis to various cardiovascular conditions, highlighting the potential for nutritional modification [ Dietary changes, probiotics, and prebiotics have shown promise in modulating gut microbiota and reducing cardiovascular risk factors] and the use of therapeutic interventions.

Key Mechanisms Linking Gut Microbiome to CVD

1. Gut Dysbiosis and Atherosclerosis
   • TMAO Pathway: High salt intake amplifies TMAO production by altering gut bacteria (e.g., reducing Lactobacillus) and upregulating hepatic enzymes. TMAO promotes plaque formation via oxidized LDL and endothelial damage.
   • SCFAs: Butyrate stabilizes the intestinal barrier and lowers blood pressure by activating HIF-1. Fiber-rich diets boost Faecalibacterium, a key SCFA producer.
   • Oscillibacter: Newly identified cholesterol-metabolizing bacteria reduce serum LDL levels.
2. Diet-Driven Inflammation
   • Ultra-processed foods decrease microbial diversity and increase Firmicutes, worsening endotoxemia.
   • Plant-based proteins (e.g., lentils) reverse red meat’s pro-TMAO effects by enriching Bacteroidetes.

Explore Infographic 1: The Gut-Heart Axis

Nutritional Strategies for Gut-Heart Health

1. Diets with Proven Benefits
   • Mediterranean Diet: Increases Oscillibacter and lowers TMAO, reducing atherosclerosis risk by 40% in recent trials.
   • Non-Industrialized Diets: High-fiber, low-processed regimens restore microbial diversity (e.g., Limosilactobacillus reuteri).
2. Functional Foods
   • Almonds: Improve microbial diversity and lower LDL.
   • Garlic + Prebiotics: Synergistically boost Akkermansia, enhancing gut barrier function.
3. Avoid
   • Ultra-processed snacks, and high-salt foods.

Explore Infographic 3: Dietary Recommendations

Clinical Interventions

1. Microbiome-Targeted Therapies
   • Fecal Transplants (FMT): Reduce TMAO by 30% in hypertensive patients.
   • Engineered Probiotics: Phase II trials show TMA lyase inhibitors lower CVD risk.
2. Personalized Approaches
   • AI-Driven Platforms: Predict individual responses to fiber/salt intake based on enterotype (Prevotella vs. Bacteroides).

Challenges and Future Directions

• Standardization: Strain-specific probiotics (e.g., L. plantarum 299v) require rigorous testing.
• Global Disparities: Migrant populations lose protective gut taxa on Western diets, necessitating region-specific guidelines.
• AI Integration: Combining microbiome data with EHRs enables precision cardiology.

Explore Infographic 5: Research Roadmap

Infographic Descriptions

1. Gut-Heart Axis Pathway: Animated flow of metabolites (TMAO, SCFAs) from gut to heart, highlighting Oscillibacter.
2. Dietary Recommendations: Interactive plate builder with filters for low-TMAO, high-fiber options.
3. Microbiome Modulation: Slider comparing gut flora pre/post FMT and phage therapy.

References

1. Tang WHW et al. Gut microbiome and cardiovascular disease. Circ Res. 2024. DOI
2. Li C et al. Oscillibacter and cholesterol metabolism. Cell. 2024. DOI
3. Verhaar B et al. Salt-driven TMAO production. Gut Microbes. 2025. DOI
4. Okunlola FO et al. Non-industrialized diets. Clin Nutr ESPEN. 2025. DOI