Probiotics in atherosclerosis: mechanisms, efficacy and future directions - a review study.

2026-03-25
Frontiers in immunology 17
- Yue Cai

PubMed: 41958663
DOI: 10.3389/fimmu.2026.1722134

Study Design

Type: Review
Methods: To systematically review the mechanisms, efficacy, and future perspectives of probiotics in atherosclerosis. Preclinical and clinical evidence was summarized, focusing on gut microbiota, TMAO, short-chain fatty acids, lipid metabolism, inflammation, and vascular function.

Background

Atherosclerosis (AS), the pathological basis of cardiovascular diseases, is a major cause of global mortality. Gut microbiota dysbiosis contributes to AS progression via trimethylamine N-oxide (TMAO), inflammation, and vascular dysfunction. Probiotics have emerged as a potential strategy against AS.

Objective

To systematically review the mechanisms, efficacy, and future perspectives of probiotics in atherosclerosis.

Methods

Preclinical and clinical evidence was summarized, focusing on gut microbiota, TMAO, short-chain fatty acids, lipid metabolism, inflammation, and vascular function.

Results

Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function. Clinical trials support beneficial effects on metabolic and vascular risk factors but are limited by small sample sizes and short durations.

Conclusions

Probiotics are a promising and safe approach for AS intervention. Future large-scale, long-term trials and optimized probiotic designs are required to facilitate clinical application.

Research Insights

Supplement	Dose	Health Outcome	Effect Type	Effect Size	Source
Bifidobacterium plantarum	—	Improved Atherosclerosis-Related Cardiovascular Risk Markers	Beneficial	Moderate	View source Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function.
Lactobacillus fermentum CECT5716	—	Improved Blood Lipid Profile	Beneficial	Moderate	View source Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function.
Lactobacillus fermentum CECT5716	—	Reduced Atherosclerosis Risk Factors	Beneficial	Moderate	View source Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function.
Lactobacillus fermentum CECT5716	—	Reduced Inflammation	Beneficial	Moderate	View source Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function.
Lactobacillus reuteri NCIMB 30242	—	Improved Blood Lipid Metabolism	Beneficial	Moderate	View source Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function.
Lactobacillus reuteri NCIMB 30242	—	Improved Vascular Endothelial Function	Beneficial	Moderate	View source Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function.
Lactobacillus reuteri NCIMB 30242	—	Reduced Cardiovascular Risk	Beneficial	Moderate	View source Clinical trials support beneficial effects on metabolic and vascular risk factors
Lactobacillus reuteri NCIMB 30242	—	Reduced Inflammation	Beneficial	Moderate	View source Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function.