From Dysbiosis to Cardiovascular Disease: The Impact of Gut Microbiota on Atherosclerosis and Emerging Therapies

The gut microbiota consists of trillions of microorganisms, mostly bacteria, which establish a symbiotic relationship with the host. The host provides a favourable environment and the essential nutrients for their proliferation, while the gut microbiota plays a key role in maintaining the host’s health. Therefore, imbalances in its composition, a state known as dysbiosis, can contribute to the onset or progression of various pathological conditions, including atherosclerosis. Atherosclerosis is a chronic, slow-progressing inflammatory disease characterised by the formation and potential rupture of atheromatous plaques in medium- and large-calibre arteries. It underlies major cardiovascular events, such as stroke and myocardial infarction, and remains a leading cause of global morbidity and mortality. The modulation of the gut microbiota using prebiotics, probiotics, and faecal microbiota transplantation (FMT) has emerged as a promising approach for preventing and managing atherosclerosis. Although numerous studies have explored these strategies, further research is needed to establish their efficacy and mechanisms. This review explores the pathophysiology of atherosclerosis, its main risk factors, and the interplay between the gut microbiota and atherosclerosis, with a particular focus on the mechanisms by which microbiota-targeted interventions, including prebiotics, probiotics, and FMT, may serve as therapeutic adjuvants in the prevention and treatment of atherosclerosis.