Cardiovascular pathology and intestinal microbiome relationship: potential targets of pharmacotherapy

Violation of the intestinal microbiota is an important component in the pathogenesis of many chronic systemic diseases, which are based on chronic inflammation, changes in cytokine secretion, increased insulin resistance, microcirculation disorders, namely: obesity, diabetes mellitus (DM), atherosclerosis, chronic heart failure (CHF). The article clarifies the importance of the main intestinal metabolites: short-chain fatty acids (SCFAs), trimethylamine (TMA) and its oxide (TMAO) in the normal functioning of the “intestine – heart”, “intestine – liver”, “intestine – pancreas” axes, and also analyzes in detail the mechanisms of their dysfunction and the consequences of these disorders. The participation of the intestinal microbiota in the regulation of carbohydrate metabolism in patients with diabetes mellitus due to the activation of the synthesis of incretin hormones produced by the SCFAs (incretin effect) is considered. The role of lipopolysaccharide in the activation of proinflammatory cytokines and reduction of incretin response is shown. It was noted that violation of epithelial integrity leads to increased endotoxin intake into the blood, increased chronic inflammation, chronic dyscirculation and potentiation of atherosclerosis. A decrease in the content of butyrate-producing bacteria that provide anti-inflammatory mechanisms in the intestinal microbiota of CHF patients is an unfavorable factor that worsens the prognosis of the disease. An important modern aspect of cardiodiabetology is the study of the effect of intestinal dysbiosis on the production of a number of active metabolites, as well as the study of possible ways of pharmacological correction of existing disorders. It has been shown that probiotics can suppress inflammation, protect and restore the intestinal mucosal barrier, as well as improve intestinal function, which is important for the complex therapy of both diabetes and cardiovascular diseases. In DM, the use of incretin therapy, which contributes to the correction of the composition of the microbiota, is promising and pathogenetically justified. 

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