Журнал «Медицина неотложных состояний» Том 18, №6, 2022
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The role of the microbiome in the development of cardiovascular disease
Авторы: S.S. Boieva (1, 2), O.A. Sliusarev (2), O.A. Raksha-Sliusareva (2), P.G. Kovalenko (2), I.A. Tarasova (3), I.L. Marychev (3)
(1) — Lithuanian University of Health Sciences, Kaunas, Lithuania
(2) — Donetsk National Medical University, Lyman, Ukraine
(3) — SI «The L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of NAMS of Ukraine», Kyiv, Ukraine
Рубрики: Медицина неотложных состояний
Разделы: Медицинские форумы
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Background. Cardiovascular diseases (CVD) remain the leading causes of high mortality and morbidity, which places a heavy burden on health and economies around the world. One of the pathogenetic mechanisms of coronary artery disease (CAD) is myocardial dysfunction or organic damage caused by insufficient blood supply, stenosis of the coronary arteries and the formation of atherosclerotic plaques. The progression of atherosclerotic plaques is considered dynamic and complex, and the detailed mechanisms that cause plaque formation, development, and displacement are largely unknown. Identification of biomarkers of the risk of destabilization and plaque rupture in patients is important to prevent the transition of coronary stability to instability and the occurrence of thrombotic events. It has been extensively researched that cardiovascular disease risk factors are obesity, high total cholesterol, and unhealthy lifestyles, including tobacco smoking, lack of exercise, and dietary risks. However, the role of these factors in the development of CVD remains unclear. These risk factors are associated with dysbacteriosis, namely, microbiome disturbances that contribute to microbiota imbalance, changes in its functional composition and metabolic activity, or a shift in their local distribution.
Given these backgrounds, it can be assumed that microbial communities may play a role in the pathogenesis of CVD.
Thus, the purpose of this study is to summarize recent studies that have demonstrated interactions between microbial communities, their metabolites, and the development of common cardiovascular diseases.
Materials and methods. A literature research was performed in PubMed and Google Scholar electronic databases using the keywords: «microbiota», «metabolites», «atherosclerosis», «coronary artery disease», «metabolism», «inflammation», «trimethylamine N-oxide», «lipopolysaccharides», «diet». Only articles in English from the last 10 years have been included.
Results. Recently, evidence has been accumulating that indicates a relationship between CVD and the formation of the microbiota. Furthermore, the gut microbiota produces bioactive metabolites can influence high cholesterol such as Trimethylamine-N-oxide (TMAO), bile acids (BA), coprostanol, short chain fatty acids (SCFA). Several recent publications have focused on circulating levels of metabolites such as TMAO, which has proinflammatory, prothrombotic, and dyslipidemic effects. Animal studies have shown that TMAO has been identified as a strong predictor of clinical vascular events, mechanically associated with the development of atherosclerosis in mice. The source of TMAO is a toxic metabolite (trimethylamine), formed during bacterial fermentation of L-carnitine or phosphatidylcholine containing products, enters the host’s bloodstream and is metabolized in the liver. Short-chain fatty acids produced by the gut microbiota may have anti-inflammatory and immunomodulatory effects and play a protective role against coronary atherosclerosis. It is important to note that bacterial lipopolysaccharides, also called endotoxin of a Gram-negative bacteria activate systemic inflammation through Toll-like receptor and initiate the formation of atherosclerotic plaques. Recently, numerous studies have shown that the structure and composition of the intestinal community in patients with coronary artery disease and healthy people differ significantly. In addition, a prospective study has showed that the composition of the intestinal microbiota of patients with heart disease is relatively high in Collinsella, while in the healthy group there is a relatively higher content of Roseburia and Eubacterium. Koren et al. found Chryseomonas, Veillonella and Streptococcus in plaque samples and showed that several bacterial phylotypes from the gut are common to athe–rosclerotic plaques and correlate with cholesterol levels. Besides, recent evidence has suggested that Lactobacillus plantarum 299v supplementation improves vascular endothelial function and reduces inflammatory biomarkers in men with stable coronary artery disease.
Conclusions. Based on the above, it can be noted that the microbiota is closely associated with coronary heart disease, and studies have confirmed a different composition in patients with coronary heart disease and in healthy people. Recent data have shown that an important role in the development of atherosclerosis is played by bacterial metabolites, the level of which depends on the microbial composition of the intestine. Thus, microbiota analysis could potentially be useful in predicting cardiovascular risk.