Gut Microbiota and Risk for Atherosclerosis: Current Understanding of the Mechanisms

Commensal bacteria inhabiting mucosal surfaces of the body contribute to the development of numerous diseases including cardiovascular and metabolic diseases. Disruption of the otherwise beneficial homeostatic gut microbial ecosystem leads to dysbiosis, and consequent augmentation of the risk of various diseases. We aim to discuss current understanding of the mechanisms whereby microbiota might affect the pathogenesis of atherosclerosis and its associated risk factors. In particular, we critically review the role of gut microbiota in the modulation of inflammation and lipid metabolism and discuss how they can aggravate atherosclerotic lesion formation. We also review the role of gut microbiota-derived metabolites such as short-chain fatty acids and trimethylamine N-oxide, highlighting their harmful and beneficial effects in various pathophysiological conditions. Lastly, we delve into therapeutic manipulations, such as the use of prebiotics, probiotics, and small molecules directed at reshaping the gut microbial community, in the hope of translating these findings into clinical practice.