How Gut Health May Affect Arteries
GUT microbiome changes may influence artery health, inflammation, and the risk of peripheral artery disease. A narrative review examining the link between gut bacteria and vascular disease suggests that disruptions in the gut microbiome could play a meaningful role in the development of atherosclerosis and PAD, alongside established risk factors such as diet, diabetes, hypertension, smoking, and obesity.
The review describes gut dysbiosis, or an imbalance in the gut microbial environment, as a possible driver of vascular damage. In people with vascular disease, researchers noted higher levels of bacteria linked to pro-inflammatory and pro-atherogenic activity, including Enterobacteriaceae, Streptococcus spp., Lachnoclostridium, and Family XI. At the same time, beneficial bacteria that produce short-chain fatty acids, including Roseburia, Faecalibacterium, Coprococcus, and Ruminococcaceae, appeared to be reduced.
Why the Gut Microbiome Matters
Much of the discussion centers on two key groups of gut-derived metabolites. One is trimethylamine N-oxide, or TMAO, which is produced through microbial and liver metabolism of compounds found in animal-derived foods. The review links higher TMAO levels to endothelial dysfunction, inflammation, platelet reactivity, and greater vascular risk.
The other is short-chain fatty acids, or SCFAs, including acetate, propionate, and butyrate. These compounds were described as potentially protective, with anti-inflammatory effects and links to better insulin sensitivity, improved endothelial function, and lower vascular risk. In simple terms, the review presents the gut microbiome as a system capable of producing signals that may either support vascular health or contribute to disease progression.
A Closer Look at PAD
The review also highlights a growing connection between the gut microbiome and peripheral artery disease. Certain bacterial groups, including Coprococcus 2 and Ruminococcaceae subtypes, were associated with lower PAD risk, while Lachnoclostridium and Family XI were associated with greater risk. The proposed mechanisms include reduced SCFA production, increased inflammatory signaling, impaired nitric oxide activity, and higher TMAO levels.
Can the Microbiome Be Modified?
Potential strategies to support a healthier gut microbiome included probiotics, prebiotics, the Mediterranean diet, and fecal microbiota transplantation. Among probiotics, Lactobacillus rhamnosus GG was highlighted for its possible role in lowering TMAO. The Mediterranean diet was presented as especially favorable because it supports SCFA-producing bacteria while limiting red meat, a source of TMAO precursors.
Even so, the review emphasizes that these interventions remain investigational in this setting. Much of the available evidence is observational or based on small studies, and longer-term clinical trials are still needed before microbiome-targeted approaches can be considered established tools in vascular prevention or treatment.
Reference
Smółka L et al. The impact of the gut microbiome on the development of atherosclerosis and peripheral arterial disease: A narrative review. Przegl Epidemiol. 2025;79(4):580-594.
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