The Promising Role of Probiotics in the Prevention of Cardiovascular Risk Factors and Their Implication in Reducing Coronary Artery Disease: A Literature Review

Abstract

Coronary artery disease (CAD) remains one of the most common causes of mortality across the globe, which is strongly associated with modifiable risk factors such as hypertension, hyperlipidemia, type 2 diabetes, and obesity. The role of the gut microbiota in influencing these factors has been established recently. Probiotics, which can modulate gut microbiota, have been investigated as a potential strategy to reduce cardiovascular risk. This review aims to evaluate current evidence on the role of probiotics in reducing CAD risk factors and to explore the mechanisms through which probiotics may support cardiovascular health. This narrative review was conducted using studies published within the last five years. The search included databases such as PubMed, Google Scholar, Medline, and ResearchGate. The selection focused on randomized controlled trials (RCTs), meta-analyses, and reviews that examined the impact of probiotics on CAD and its associated risk factors. Findings from several RCTs and meta-analyses show that probiotic supplementation is associated with improved lipid profiles (including lower LDL-C and triglycerides), better glycemic control, reduced inflammatory markers, and modest reductions in blood pressure and obesity measures. However, results across studies vary due to differences in sample size, duration, probiotic strains, and measured outcomes. Probiotics may offer a beneficial, non-pharmacological option to support conventional CAD therapies, particularly by targeting key modifiable risk factors. While early results are encouraging, further large-scale, long-term studies are necessary to confirm their clinical effectiveness and guide standardized recommendations.

Keywords: cardiovascular disease; coronary artery disease; gut microbiota; hypercholesterolemia; hypertension; obesity; pathophysiology; probiotics; type 2 diabetes.

Figure 1. The role of Bifidobacterium probiotics in lowering the risk of coronary atherosclerosis

The figure is created by using https://mindthegraph.com

Figure 2. Probiotic-gut-heart axis: Probiotics affect the heart by modulating the gut microbiota through their anti-inflammatory and anti-oxidative properties, which inhibit the plaque formation of atheroma. The role of trimethylamine N-oxide (TMAO) and lipopolysaccharides (LPS) in the development of atherosclerosis.

The figure is created by using https://mindthegraph.com and the design of the figure incorporates features from Microsoft Windows SmartArt.

Figure 3. The mechanism of Bifidobacterium probiotics that affect cardiovascular health by lowering diabetes mellitus (DM) risk through the secretion of glucagon-like peptide-1 (GLP-1) and lowering lipid levels

The figure is created by using https://mindthegraph.com.

Figure 4. Number of participants who reported using dietary supplements (DS), specifically probiotic supplements, based on the National Health and Nutrition Examination Survey (1999–2018).

Figure 5. Number of participants using non-food sources of probiotics, prebiotics, or synbiotics (NFP), based on data from the National Health and Nutrition Examination Survey (1999–2018).

Figure 6. Pie chart illustrating the distribution of dietary supplement use among adults.

Created the charts using Excel.

Figure 7. Mechanism of probiotics in lowering blood pressure by modulating the gut microbiota, stabilizing intestinal immunity by reducing the Firmicutes/Bacteroidetes (F/B) ratio, and inhibiting lipopolysaccharide (LPS). Then, it deactivates Toll-like receptor 4 (TLR4), downregulates p38 mitogen-activated protein kinase (p38MAPK), and inhibits tumor necrosis factor-α (TNF-α) along with nitric oxide (NO).

The figure is created by using https://mindthegraph.com and The design of the figure incorporates features from Microsoft Windows SmartArt.