Gut Microbiome-Based Management of Patients with Heart Failure: JACC Review Topic of the Week (JACC May 2023-1)-Article: Gut Microbiome-Based Management of Patients with Heart Failure: JACC Review Topic of the Week (JACC May 2023-1)

Article: Gut Microbiome-Based Management of Patients with Heart Failure: JACC Review Topic of the Week (JACC May 2023-1)

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The review, "Gut Microbiome-Based Management of Patients With Heart Failure," published by the Journal of the American College of Cardiology, highlights the critical role the gut microbiome may play in the personalized treatment of heart failure (HF). Chronic HF affects over 6 million adults in the US and remains a significant cause of morbidity and mortality despite medical advancements. Precision medicine, which tailors treatment based on individual biological differences, could dramatically improve HF management outcomes, and the gut microbiome is a promising target in this approach.<br /><br />Studies have shown that HF is associated with notable changes in gut microbiota, including decreased microbial diversity and an increase in pathogenic bacteria. This dysbiosis—a microbial imbalance—contributes to disease mechanisms by impairing the gut barrier, allowing harmful microbes and their products into the bloodstream. Such disruptions initiate systemic inflammatory responses that exacerbate HF.<br /><br />Key microbial metabolites involved include:<br />1. **Lipopolysaccharide (LPS)**: Promotes inflammation and cardiovascular dysfunction.<br />2. **Short-chain fatty acids (SCFAs)**: Generally protective, aiding in gut barrier function and regulating inflammation.<br />3. **Trimethylamine-N-oxide (TMAO)**: Produced from dietary choline and L-carnitine and linked with adverse cardiovascular events.<br />4. **Amino Acid Metabolites**: Compounds like phenylacetylglutamine can adversely impact heart function.<br />5. **Bile Acids**: Engage in processes affecting heart and vascular health.<br /><br />The review underscores the bidirectional influence between the heart and gut, wherein heart dysfunction affects gut health and vice versa. Emerging evidence suggests that harnessing gut microbiota could aid in better risk stratification, development of novel biomarkers, and optimization of current therapies, offering a path toward personalized nutrition and medication based on microbiome profiles.<br /><br />While promising, the translation of such findings into clinical practice is hampered by current challenges in microbiome research methodologies and the complexity of human-microbiome interactions. Coordinated and interdisciplinary efforts are imperative for future clinical applications, potentially transforming HF patient care and improving outcomes.

Keywords

gut microbiome

heart failure

precision medicine

microbial diversity

dysbiosis

inflammation

lipopolysaccharide

short-chain fatty acids

trimethylamine-N-oxide

personalized treatment