Anti-Inflammatory, Antioxidant, Metabolic and Gut Microbiota Modulation Activities of Probiotic in Cardiac Remodeling Condition: Evidence from Systematic Study and Meta-Analysis of Randomized Controlled Trials

Abstract

Heart failure (HF) is a global pandemic with increasing prevalence and mortality rates annually. Its main cause is myocardial infarction (MI), followed by rapid cardiac remodeling. Several clinical studies have shown that probiotics can improve the quality of life and reduce cardiovascular risk factors. This systematic review and meta-analysis aimed to investigate the effectiveness of probiotics in preventing HF caused by a MI according to a prospectively registered protocol (PROSPERO: CRD42023388870). Four independent evaluators independently extracted the data using predefined extraction forms and evaluated the eligibility and accuracy of the studies. A total of six studies consisting of 366 participants were included in the systematic review. Probiotics are not significant in intervening left ventricular ejection fraction (LVEF) and high-sensitivity C-reactive protein (hs-CRP) when compared between the intervention group and the control group due to inadequate studies supporting its efficacy. Among sarcopenia indexes, hand grip strength (HGS) showed robust correlations with the Wnt biomarkers (p < 0.05), improved short physical performance battery (SPPB) scores were also strongly correlated with Dickkopf-related protein (Dkk)-3, followed by Dkk-1, and sterol regulatory element-binding protein 1 (SREBP-1) (p < 0.05). The probiotic group showed improvement in total cholesterol (p = 0.01) and uric acid (p = 0.014) compared to the baseline. Finally, probiotic supplements may be an anti-inflammatory, antioxidant, metabolic, and intestinal microbiota modulator in cardiac remodeling conditions. Probiotics have great potential to attenuate cardiac remodeling in HF or post-MI patients while also enhancing the Wnt signaling pathway which can improve sarcopenia under such conditions.

Keywords: Cardiac remodeling; Gut microbiota modulation; Heart failure; Myocardial Infarction; Probiotic; Sarcopenia.

Fig. 1

Prisma flow diagram of study selection

Fig. 2

Analysis for risk of bias. Six studies were analyzed for a variety of biases using the tools in RevMan software. A Traffic light plot of study quality assessment based on Cochrane RoB Tool 2.0. B Summary plot of study quality assessment based on Cochrane RoB 2.0. The risk for bias that was analyzed was evaluated using the Revised Tool RoB 2.0, which has five domains for studies. The results were recorded in the domain file bias (.xlsx) and then processed to the ROBVIS website for display and summary of the study

Fig. 3

Forest plot probiotics vs. placebo regarding left ventricle ejection fraction (LVEF)

Fig. 4

Forest plot probiotics vs. placebo regarding high-sensitivity C-reactive protein (hs-CRP)

Fig. 5

Mechanism of probiotics in cardiac remodeling condition with amelioration of sarcopenia under such conditions. Created by Fahrul Nurkolis using Biorender Premium