Probiotics, Prebiotics and Synbiotics-A Promising Strategy in Prevention and Treatment of Cardiovascular Diseases?

Abstract

Recent evidence suggests that probiotics, prebiotics and synbiotics may serve as important dietary components in the prevention (especially) and treatment of cardiovascular diseases (CVD), but the recommendations for their use are often based on brief reports and small clinical studies. This review evaluates the current literature on the correlation between CVD and probiotics, prebiotics and synbiotics. Although research on probiotics, prebiotics and synbiotics has grown exponentially in recent years, particularly regarding the effect of probiotics on CVD, their mechanisms have not been clearly defined. It has been proposed that probiotics lower cholesterol levels, and may protect against CVD, by increasing bile salt synthesis and bile acid deconjugation. Similar effects have also been observed for prebiotics and synbiotics; however, probiotics also appear to have anti-oxidative, anti-platelet and anti-inflammatory properties. Importantly, probiotics not only have demonstrated effects in vitro and in animal models, but also in humans, where supplementation with probiotics decreases the risk factors of CVD. In addition, the properties of commercial probiotics, prebiotics and synbiotics remain undetermined, and further experimental research is needed before these substances can be used in the prevention and treatment of CVD. In particular, well-designed clinical trials are required to determine the influence of probiotics on trimethylamine-N-oxide (TMAO), which is believed to be a marker of CVDs, and to clarify the long-term effects, and action, of probiotic, prebiotic and synbiotic supplementation in combination with drug therapy (for example, aspirin). However, while it cannot be unequivocally stated whether such supplementation yields benefits in the prevention and treatment of CVDs, it is important to note that clinical studies performed to date have not identified any side-effects to use.

Keywords: cardiovascular disease; prebiotic; probiotic; synbiotic.

Figure 1

Effect of trimethylamine-N-oxide (TMAO) on cardiovascular diseases (CVDs) (modified) [70] More details in text.

Figure 2

Effect of probiotics on trimethylamine-N-oxide (TMAO) accumulation and changes in cardiovascular functions. More details in text (modified) [69].

Figure 3

The effect of probiotics, prebiotics and synbiotics on cardiovascular disease. Probiotics lower the level of cholesterol by increasing bile salt synthesis and bile acid deconjugation. Probiotics also have anti-oxidative, anti-platelet and anti-inflammatory properties, and hence may offer protection from cardiovascular diseases. One proposed model of preventing the CVD-induced accumulation of TMAO may be probiotic supplementation. However, prebiotics and synbiotics may also decrease the level of total cholesterol and offer similar protection from cardiovascular disease. More details in text.