Probiotics and Phytoantioxidants Target Coronary Endothelial Dysfunction in Irregular Sleep- and Obesity-Associated Cardiometabolic Syndrome

Coronary endothelial dysfunction is an early and critical vascular abnormality in cardiometabolic syndrome, intensified by irregular sleep patterns and excess adiposity. Disruption of circadian rhythm and accumulation of visceral fat impair nitric oxide signaling and promote arterial stiffness through endothelial injury. The gut vascular axis further contributes via microbial imbalance and endotoxin translocation, elevating systemic inflammation and vascular stress. Clinical evidence indicates that probiotics restore microbial equilibrium and attenuate vascular damage. Phytoantioxidants such as curcumin, berberine, and epigallocatechin gallate exert endothelial protective effects by enhancing nitric oxide synthase activity and suppressing inflammatory mediators. These compounds also activate the nuclear factor erythroid two related factor two (Nrf2) pathway, which regulates oxidative balance and promotes vascular resilience. Together, probiotics and phytoantioxidants represent a promising integrative approach to mitigate coronary endothelial dysfunction in populations affected by sleep disturbance and obesity. This review narratively integrates current molecular and clinical findings to delineate precision-guided pathways for endothelial recovery and cardiometabolic risk reduction.