Purpose of Review
Over the past decade, the gut microbiome has been shown to play an important role in the pathogenesis of heart failure (HF) and serves as a mediator that links host genomes and environmental exposure (especially dietary intake) to the development and progression of HF. Given that alterations in gut microbial composition and metabolism are commonly seen in patients with HF, the use of gut microbial metabolites as diagnostic and prognostic biomarkers, as well as novel therapeutic targets for HF, is promising.
Alterations in gut microbial composition and function have bidirectional relationships with HF. Gut microbial metabolites, including short-chain fatty acids, bile acids, trimethylamine N-oxide (TMAO), and amino acid metabolites, have been shown to play a significant role in HF. For example, TMAO has been consistently demonstrated as an independent predictor of worse prognosis in patients with HF, and a potential therapeutic target for cardiac remodeling and HF. However, clinical studies on dietary interventions targeting gut microbial metabolites have demonstrated inconsistent findings, which could be from variations in the study population, gut microbial communities, and study designs.
Measurement of gut microbial metabolites can improve risk stratification and potentially identify HF patients who are more likely to respond to personalized pharmacologic or dietary interventions targeting specific pathways associated with the gut microbiome.
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Dr. Tang is supported by grants from the National Institutes of Health (R01HL126827).
Conflict of Interest
Dr. Chaikijurajai has no relationships to disclose. Dr. Tang is a consultant for Sequana Medical A.G., Owkin Inc, and Relypsa Inc, and has received an honorarium from Springer Nature for authorship/editorship and American Board of Internal Medicine for exam writing committee participation, all unrelated to the contents of this paper.
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This article is part of the Topical Collection on Biomarkers of Heart Failure
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Chaikijurajai, T., Tang, W.H.W. Gut Microbiome and Precision Nutrition in Heart Failure: Hype or Hope?. Curr Heart Fail Rep 18, 23–32 (2021). https://doi.org/10.1007/s11897-021-00503-4
- Gut microbiome
- Heart failure
- Short-chain fatty acid
- Bile acids