Every year, 805,000 Americans suffer from a heart attack,1 a condition tied to clogged arteries, high cholesterol, and high blood pressure, as most people are already aware of. But while these factors matter, a recent study shows that there’s another crucial predictor that many people often overlook — your gut microbiome.
Composed of trillions of bacteria living in your intestines, your gut microbiome affects more than your digestive function; it’s essential to your overall health. Now there’s proof showing that having an imbalanced gut microbiome could increase your risk for a heart attack.
Gut Bacteria Scoring System Predicts Future Heart Attacks
A recent study published in the European Medical Journal determined whether gut microbial patterns could be used to predict the risk of major adverse cardiovascular events (MACE) in people with coronary heart disease (CHD).2 The research is part of the CORDIOPREV study, an ongoing randomized controlled trial involving over 1,000 CHD patients from Europe.3
• Researchers focused on high-risk CHD patients — They analyzed data from 679 participants, particularly adults who had already experienced a coronary event at least six months prior to joining the study. The researchers wanted to find out which of these individuals were silently trending toward another serious event, despite receiving conventional care.
• They looked at 10 bacteria strains linked to cardiac risk or protection — These bacterial species were closely tied to either a higher risk of future cardiovascular problems or protective effects. The researchers combined the presence or absence of these bacteria into a single algorithm, developing what they called an intestinal microbiota-based risk score.
This score predicted which patients were most likely to suffer new MACE, even before those events occurred.
• The gut-based risk model predicted worse health metrics — CHD patients who scored high on the microbiota-based risk model had a greater incidence of diabetes, larger waistlines, higher blood pressure, and worse blood sugar control (including elevated glucose and glycated hemoglobin levels) compared to those who hadn’t experienced a recent event.
The study findings suggest that the gut microbiome not only reflects cardiovascular risk — it could be driving it as well. According to the researchers, “These results reinforce the relationship between intestinal microbiota and CVD and suggest that a microbiota profile is associated with MACE in CHD patients, in addition to higher endotoxaemia.”4
CHD Patients Have a Different Gut Microbial Makeup
The gut bacteria themselves weren’t the only clue. According to the featured study, CHD patients have more distinct gut microbiome diversity patterns compared to healthy individuals without cardiovascular disease.5,6
Specifically, the patients with heart disease had altered alpha-diversity (meaning fewer unique bacterial species) and beta-diversity (a greater shift in microbial community makeup). These are both signs of dysbiosis, or what’s known as gut imbalance.
• High levels of Lactobacillus were found in patients with recent events — One key culprit was the genus Lactobacillus. In CHD patients who had recently experienced another major event, levels of Lactobacillus were significantly higher. That might surprise you, since Lactobacillus is known as a beneficial probiotic.
However, not all species within the Lactobacillus genus are friendly. Some have been detected in the bloodstream of patients with heart attacks and linked to dangerous immune activation. In this case, their presence seemed to indicate a higher risk, not protection.
• Escherichia coprostanoligenes was linked to trimethylamine N-oxide (TMAO) production — The researchers found that E. coprostanoligenes levels were elevated in patients who had suffered new events. This particular strain is known to produce trimethylamine (TMA), the compound that your liver converts into trimethylamine N-oxide (TMAO).
TMAO accelerates atherosclerosis, promotes plaque instability, and increases the risk of clot formation. Hence, having E. coprostanoligenes strongly suggests that microbial metabolism of certain foods could be directly influencing heart health outcomes.
• Leaky gut and high lipopolysaccharide (LPS) levels were linked to heart risk — Perhaps the most telling detail was the association between LPS levels and cardiovascular events. LPS is an endotoxin released by certain gut bacteria when they die.
When your gut barrier is compromised — a condition often called “leaky gut” — LPS seeps into the bloodstream, where it causes inflammation, damages tissues, and triggers immune overdrive. According to the study findings, CHD patients with higher circulating LPS were more likely to experience major cardiac events.
Unlike blood pressure or cholesterol, which are routinely monitored, microbial patterns are still ignored in most cardiology clinics and diagnostic processes. But research like this makes it clear that they shouldn’t be, as they provide significant insights into your overall health.
Global Studies Show How the State of Your Gut Bacteria Shapes Your Heart Disease Risk
A 2022 analysis published in the journal Frontiers in Cardiovascular Medicine examined two decades’ worth of scientific studies connecting CHD to your gut microbiome. This large-scale analysis pulled data from 457 publications between 2002 and 2022.7
The goal was simple but powerful — map out what scientists around the world have found when it comes to how your gut bacteria are linked to heart disease, and figure out where the science is heading.
• Most studies focused on high-risk or diagnosed CHD patients — The study looked at research involving adults — most of them already diagnosed with coronary artery disease or at high risk for developing it. These papers covered the most commonly studied bacterial substances as well as a wide range of issues — including dietary patterns, inflammation, and microbial metabolites — and how all of these connect back to cardiovascular damage.
• Natural therapies are gaining traction in gut-heart research — A standout pattern was the shift in research toward finding ways to improve gut health using natural therapies. Chinese researchers are now leading the field in exploring herbal remedies, seaweed compounds, and plant-based interventions like berberine, ginseng, and mulberry leaf extract. Many of these target the gut first and the heart second.
• Natural remedies like berberine rewire your microbiome — One of the most promising examples was berberine. According to the researchers, it was helpful in “improving hypercholesterolemia and systemic inflammation,” and “inhibiting the production of TMA/TMAO and choline-to-TMA conversion.”
Berberine also increased levels of Akkermansia,8 a protective gut species linked to reduced inflammation, improved insulin sensitivity, and better cholesterol profiles. Read more about this compound in “The Neuroprotective Benefits of Berberine.”
• Fecal transplants show your gut alone drives disease — The researchers also explored fecal microbiota transplantation (FMT), a technique where stool from a healthy donor is implanted into someone else’s gut to reset microbial balance.
In one experiment, researchers transferred gut bacteria from humans with high TMAO into mice. The mice rapidly developed plaque in their arteries, even though their diets hadn’t changed. This showed that the gut profile alone was enough to trigger cardiovascular disease.
• Bile acids calm artery inflammation — Once thought of as just a digestive aid, bile acid was found to play a key role in regulating blood fats and immune function. Gut bacteria modify your bile acids into signaling molecules that help control inflammation and cholesterol. One type, lithocholic acid, was even suggested as a biomarker for coronary plaque. The receptor it activates, known as TGR5, was shown to suppress inflammatory responses in artery walls.
• Short-chain fatty acids help lower inflammation and regulate blood pressure — Another powerful pathway involves short-chain fatty acids (SCFAs), which are produced when certain gut bacteria ferment dietary fiber. These fatty acids — particularly one called butyrate — regulate blood pressure, improve blood vessel function, and even influence hunger hormones.
In animal studies, SCFAs lowered inflammation in heart tissue and supported post-heart-attack healing. Human studies are now trying to confirm if these same effects hold true across different populations.
Researchers are now building a complete roadmap of how gut bacteria either protect or destroy your cardiovascular system. And unlike genetic risk, making changes to your microbiome is possible. That means your daily choices — what you eat, how you manage stress, whether you use probiotics or natural therapies — aren’t more than just lifestyle preferences — they’re levers that shift your heart disease risk at the root level.
Simple Strategies to Maintain a Healthy Gut Microbiome
If you’re dealing with CHD or have reason to worry about future heart issues, optimizing your gut health must be a primary strategy to reduce your risk of cardiovascular events. Here are basic tips to help you nurture your gut:
• Skip vegetable oils and processed foods — The modern diet is full of processed foods rich in vegetable oils that make it harder for your cells to produce energy, disrupting your gut bacteria. These oils — like the ones in fried foods, sauces and salad dressings — contain something called linoleic acid (LA), which acts like a poison to your mitochondria. Switching to healthy fats like grass fed butter or ghee keeps things running smoothly.
• Choose your carbs wisely — Carbs are key for giving your cells energy, especially since glucose is what your mitochondria (the powerhouses in your cells) love to use. To keep your gut happy, aim for about 200 to 250 grams of carbs a day if you’re an average adult — more if you’re super active. This step boosts your energy and supports your gut health, which makes a difference with MS symptoms.
Start slow with gentler options like white rice or whole fruits to let your gut adjust without causing trouble. If your gut health is compromised, too much fiber will only feed bad bacteria, making your symptoms worse. As your gut improves, add more veggies, whole grains or starches.
• Once your gut feels better, eat more fiber — Fiber is the primary fuel for your beneficial gut microbes, allowing them to produce SCFAs like butyrate that strengthen your gut barrier. Also eat more resistant starches like cooked-then-cooled potatoes or green bananas — they fuel butyrate production.
Remember — Your gut is always sending messages to your heart. You get to decide what kind of messages it sends. Start with these simple steps, and you’ll be rebuilding your foundation, from the inside out.
Frequently Asked Questions (FAQs) About Your Gut Microbiome and Heart Attack Risk
Q: How does my gut microbiome affect my heart health?
A: Your gut microbiome — made up of trillions of bacteria in your intestines — has a direct impact on your cardiovascular system. Recent research shows that certain gut bacteria produce compounds like TMAO and LPS, which contribute to inflammation, plaque buildup, and blood clotting. These factors increase your risk of heart attacks and other major cardiovascular events. If your gut bacteria are out of balance, the risk to your heart rises dramatically.
Q: What is the intestinal microbiota-based risk score, and why does it matter?
A: This scoring system was developed in the European CORDIOPREV study to predict which patients with CHD are at greater risk of having another major cardiac event. It’s based on the presence or absence of 10 specific bacterial strains linked to either risk or protection. Patients with a high-risk score had higher rates of diabetes, obesity, high blood pressure, and poor blood sugar control — even before symptoms of another heart problem showed up.
Q: What are the harmful bacteria and compounds linked to heart attacks?
A: The study highlighted specific bacteria like Escherichia coprostanoligenes, which produces TMA — a precursor to TMAO, a compound known to accelerate plaque formation and increase clot risk. Elevated levels of Lactobacillus were also found in CHD patients with recent events, suggesting that some strains contribute to immune overactivation. Additionally, high LPS levels — often caused by a leaky gut — were tied to inflammation and higher heart risk.
Q: What do global studies say about gut-heart connections?
A: A 2022 global analysis of 457 studies confirmed that gut bacteria play a key role in heart disease. It identified specific microbial metabolites like TMAO, bile acids, and SCFAs as critical players. These compounds act like messengers that influence inflammation, blood vessel function, and cholesterol regulation.
The research also pointed to natural therapies like berberine, ginseng, and fecal transplants as promising tools to shift your gut ecology in a heart-friendly direction.
Q: What steps must I take to improve my gut and protect my heart?
A: Supporting your gut microbiome through diet and lifestyle will help reduce your heart disease risk. Start by cutting out seed oils and processed foods, as they feed harmful bacteria and increase inflammation. Eat the right types of carbs — like whole fruits and white rice — and gradually reintroduce fiber and resistant starches as your gut improves.
Natural compounds like berberine also promote beneficial bacteria and reduce harmful ones. Every choice you make helps shape your gut — and your heart health along with it.
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