Abstract
Cardiovascular disease (CVD) has become one of the leading causes of poor
lifelong health and well-being. Meanwhile, the microbiome has emerged as one of the
key determinants of human cardiometabolic homeostasis and the risk of CVD. While
the clustering of the microbiome into phylum ratios or enterotypes has been correlated
to specific disease phenotypes and population characteristics, the composition of a
typical ‘healthy human microbiome’ is yet to be defined. Several population-based
studies have shown an association between certain microbial species with CVD,
although the inconsistencies have made the interpretation of such associations very
difficult as it is not possible to pinpoint microbial populations associated with CVD.
However, here we discuss current evidence on the role of the microbiome and its
metabolites on the risk of CVD. We further explore current clinical studies
investigating prebiotics and probiotics as potential therapeutic targets to modulate the
microbiome for the benefit of the host to prevent cardiometabolic diseases. We
highlight that further work to understand the role of specific species/sub-species,
strains and polymorphisms within those strains, as well as microbial gene expression
profiles and their respective metabolites is required. Coupled with high-resolution
metagenomics and metabolomics as well as a unified approach in characterising
common gut microbial communities based on global population observations, this
would provide better indicators of disease phenotype and a better framework for a
divergence to dysbiosis. The challenges that will need to be overcome in order to
define a healthy microbiome and advance the clinical use of prebiotics and probiotics
as well as faecal microbiota transplantation will also be discussed.