Review

Microbial modulation of cardiovascular disease

Published online:

Abstract

Although diet has long been known to contribute to the pathogenesis of cardiovascular disease (CVD), research over the past decade has revealed an unexpected interplay between nutrient intake, gut microbial metabolism and the host to modify the risk of developing CVD. Microbial-associated molecular patterns are sensed by host pattern recognition receptors and have been suggested to drive CVD pathogenesis. In addition, the host microbiota produces various metabolites, such as trimethylamine-N-oxide, short-chain fatty acids and secondary bile acids, that affect CVD pathogenesis. These recent advances support the notion that targeting the interactions between the host and microorganisms may hold promise for the prevention or treatment of CVD. In this Review, we summarize our current knowledge of the gut microbial mechanisms that drive CVD, with special emphasis on therapeutic interventions, and we highlight the need to establish causal links between microbial pathways and CVD pathogenesis.

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Acknowledgements

The authors are supported by grants from the US National Heart Lung and Blood Institute, the US Office of Dietary Supplements and the US National Institute on Alcohol Abuse and Alcoholism (grants R01HL122283 (J.M.B.), P50AA024333 (J.M.B.), R01HL103866 (S.L.H.), P01HL076491 (S.L.H.), R01HL126827 (S.L.H.) and R01DK106000 (S.L.H.)) as well as the Cleveland Clinic Liver Tumor Center of Excellence.

Author information

Affiliations

  1. Department of Cellular and Molecular Medicine, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, NC-10, Cleveland, Ohio 44195, USA.

    • J. Mark Brown
    •  & Stanley L. Hazen

Authors

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Contributions

J.M.B. and S.L.H. substantially contributed to the discussion of content and the review and editing of the manuscript before submission.

Competing interests

S.L.H. is named as inventor on pending and issued patents held by the Cleveland Clinic relating to cardiovascular diagnostics and therapeutics. He is also a paid consultant for P&G and has received research funds from Astra Zeneca, P&G, Pzer Inc., Roche Diagnostics and Takeda. S.L.H. has also received royalty payments for inventions or discoveries related to cardiovascular diagnostics or therapeutics from Cleveland HeartLab, Esperion and Siemens. J.M.B. declares no competing interests.

Corresponding authors

Correspondence to J. Mark Brown or Stanley L. Hazen.

Glossary

Pattern recognition receptors

(PRRs). Host sensors that detect molecules typical for pathogens.

Atherosclerosis

A disease process in which the wall of an artery becomes thickened and inflamed owing to the accumulation of inflammation cells and lipids.

Thrombosis

The formation of a clot inside a vessel.

Ischaemic stroke

A stroke that occurs when a blood vessel to the brain is blocked by a blood clot.

Metabolome

The complete set of small-molecule chemicals found within a biological sample.

Transient ischaemic attack

A brief episode of neurological dysfunction caused by lack of blood flow to the brain; also called a 'mini-stroke'.

Glycaemia

The level of glucose in an individual's blood

Detergents

A surfactant or mix of surfactants that has cleaning or membrane-disturbing properties.

Taurine

A major sulfur-containing amino acid.

Postprandial state

The state immediately following a meal.