Scientists have identified a specific gut microbiota profile that can help forecast future heart attacks and major cardiovascular events in patients with coronary heart disease (CHD). The findings, published in the European Heart Journal, provide promising evidence that the gut microbiome may become a valuable tool in personalizing treatment and improving preventive strategies in cardiovascular care.
Understanding the Link Between the Gut and the Heart
Cardiovascular disease (CVD) continues to be the leading cause of death worldwide. Despite medical advances, many CHD patients experience recurring major adverse cardiovascular events (MACE) like heart attacks and strokes. Researchers have increasingly focused on the gut microbiome—the diverse community of microorganisms in the digestive tract—as a contributor to cardiovascular health.
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When the intestinal barrier is compromised, bacterial toxins such as lipopolysaccharides (LPS) can enter the bloodstream, triggering inflammation and damaging blood vessels. This contributes to the progression of atherosclerosis, the buildup of plaque in the arteries that leads to heart disease. These findings have sparked interest in the gut microbiome as both a biomarker and therapeutic target in CVD management.
The CORDIOPREV Study Design and Goals
The study is part of the ongoing CORDIOPREV trial, a randomized controlled study involving 1,002 individuals with documented coronary heart disease. For this microbiome-focused analysis, researchers used data from 679 patients who had experienced their last coronary event at least six months prior. A control group of 375 healthy individuals with no history of cardiovascular disease was also included for comparison.
The study aimed to identify microbial signatures that could predict new adverse cardiovascular events and develop a risk scoring system based on microbiota composition.
Key Findings: Microbiota Differences Predict Heart Attack Risk
CHD patients with a recent history of MACE were found to have higher rates of diabetes, larger waist circumferences, elevated blood glucose, and higher blood pressure compared to those who did not experience recent events.
Researchers identified ten bacterial taxa that were either positively or negatively associated with the likelihood of future cardiovascular events. These microbes were used to develop a microbiota-based risk score, which successfully stratified patients by risk level.
Notably, CHD patients had lower alpha-diversity (a measure of microbial richness) and altered beta-diversity (microbial composition differences) compared to healthy controls. This indicates significant disruption of gut microbial ecosystems in individuals with heart disease.
Bacteria Implicated in Higher Risk
Among the notable microbes identified, Lactobacillus was more abundant in CHD patients who recently suffered major events. While generally considered beneficial, some strains of Lactobacillus have been linked to systemic inflammation when found in the bloodstream.
Another bacterium, Escherichia coprostanoligenes, was also elevated in high-risk individuals. This organism contributes to the production of trimethylamine (TMA), which is converted to trimethylamine N-oxide (TMAO) in the liver—a metabolite strongly associated with atherosclerosis and cardiovascular risk.
Importantly, CHD patients with high LPS levels were also more likely to experience MACE, suggesting that a “leaky gut” increases systemic inflammation and raises cardiovascular risk.
Limitations and Scope of the Risk Score
While the microbiota-based risk score was effective in predicting new events among CHD patients, it showed limited ability to differentiate between healthy individuals and those with non-major cardiovascular issues. This is likely because the score was specifically designed to assess risk among individuals with existing CHD.
Future refinements of the score could expand its utility to broader populations, including those at risk for primary prevention of heart disease.
Implications for Personalized Treatment
This study suggests that gut microbiota profiling could soon become a powerful tool in cardiovascular medicine. By identifying CHD patients at elevated risk for future events, clinicians can personalize care strategies—ranging from enhanced lipid-lowering therapy to gut-targeted dietary changes and probiotic supplementation.
These insights align with the growing movement toward precision medicine, where treatment plans are customized based on an individual’s unique biological characteristics, including their microbiome.
Next Steps in Research
Researchers now plan to further investigate how gut microbiota inside coronary plaques and cardiac tissue differ across age groups and treatment responses. These insights could lead to new interventions that restore microbial balance and reduce systemic inflammation in high-risk populations.
Moreover, combining microbiota profiles with existing clinical risk factors (such as cholesterol levels, blood pressure, and glucose control) could lead to more accurate and predictive cardiovascular risk models.
Conclusion: The Gut-Heart Connection Strengthened
The CORDIOPREV study reinforces the emerging view that the gut plays a crucial role in cardiovascular health. By identifying a gut microbiome signature that forecasts future heart attacks, this research opens the door to early, personalized interventions that could prevent life-threatening events in patients already battling heart disease.
Through continued research and clinical trials, scientists hope to transform microbiome science into practical tools for doctors and patients alike—ushering in a new era of heart disease prevention rooted in the microbiome.
