Andrea Rab

The study of the gut microbiome is a relatively new, rapidly growing field of medicine. Alterations in intestinal microbial composition have been implicated in a range of cardiovascular pathologies, primarily atherosclerosis, coronary artery disease, heart failure, and hypertension. Dysbiosis disrupts the balance between commensal and pathogenic bacterial species, impairs gut barrier function, activates pro-inflammatory mechanisms, and modulates the production of microbiome-derived metabolites, such as trimethylamine-N-oxide, short chain fatty-acids, and secondary bile acids. Current data underline a bidirectional relationship between cardiovascular pharmacotherapy and gut barrier dysfunction, as well as changes in gut microbial ecosystem. Commonly used drugs in heart failure management, including statins and angiotensin-converting enzyme inhibitors, may exhibit higher efficacy and better bioavailability in the presence of specific bacterial phyla. Other agents, such as cardiac glycosides, are susceptible to microbial inactivation. Certain microbial taxa can also mitigate drug-induced gut barrier injury and help restore gut homeostasis - for instance, by ameliorating aspirin-related mucosal damage. This review explores the multifaceted relationship between cardiovascular medication and the gut microbiome, synthesizes current evidence, and highlights its potential significance for precision medicine in heart failure management.