Introduction
Cardiovascular disease (CVD) is a collective term used to refer to a group of diseases affecting the heart (“cardio”) and blood vessels (“vascular”). The most common types of CVDs include Coronary Artery Disease (CAD), Myocardial Infarction (MI), and Stroke. CAD is caused by the buildup of atherosclerotic plaques in the coronary arteries, leading to narrowed blood vessels that restrict blood flow. This can cause chest pain (angina) and increase the risk of a heart attack (myocardial infarction) due to plaque rupture and clot formation. CAD remains a major cause of death worldwide, 2 MI, more commonly known as
A heart attack occurs when blood flow to a part of the heart is obstructed, typically due to a blood clot in the coronary artery, leading to damage to the heart tissue. MIs can lead to the sudden onset of cardiac arrest, depending on the extent of the damage. Stroke occurs when blood flow to the brain is
disrupted, either due to a blocked artery (ischemic stroke) or a vessel rupture and bleeding in the brain (hemorrhagic stroke). Stroke can lead to long-term disability or death, depending on the affected brain area and its severity. The prevalence of CVDs differs greatly by region and is affected by the environment, lifestyle, genetics, and healthcare access. In high-income countries, such as the United States, Canada, and Western European countries, CVD has long been a leading cause of death. Although CVD rates have decreased in recent years due to advanced healthcare and prevention strategies employed in these countries, CVD remains significant in countries with rising rates of obesity, diabetes,
and hypertension due to lifestyle and diet. Additionally, in low-middle-income countries, such as India, China, and many in Sub-Saharan Africa, the prevalence of CVDs is sharply rising due to urbanization, changes in diet, and other increasing risk factors. These regions face challenges in access to
healthcare, early detection, and treatment strategies, leading to significantly delayed diagnosis and disease management. In Asia, countries such as Japan and South Korea have an increasing rate of CVD, mainly due to westernized lifestyle factors. Southeast Asian countries, such as Indonesia and Vietnam, are also victims of this increase in CVDs due to urbanization. A primary contributor to this is the Western diet and high-fat diets, which are characterized by a high intake of red meat, processed foods, refined sugar, and saturated fats. Ongoing research explores the role of the gut microbiome as
a primary factor in the pathophysiology of cardiovascular diseases. The gut microbiota is a vast microbiological community, full of millions of microorganisms, that plays an important role
in the metabolism of dietary compounds. Dysbiosis, which is an imbalance in gut microbiota composition, has been related to systemic inflammation, metabolic disorders, and endothelial dysfunction.
Additionally, certain metabolites produced by the gut microbiome can have direct impacts on human
health. Trimethylamine N-oxide (TMAO), a metabolite of gut microbiota derived from dietary precursors such as choline, phosphatidylcholine, and carnitine, has come to light for its link with increased cardiovascular risk. These precursors, typically found in foods like eggs, red meat, and dairy products,
are metabolized by the gut microbiota into trimethylamine and subsequently oxidized to TMAO by flavin monooxygenase 3 (FMO3) in the liver. In recent years, research has focused on sex-specific differences in gut microbiome, specifically TMAO production and its impact on CVD. However, this area
remains incompletely understood. Research suggests that differences in hormonal activity, metabolic pathways, and lifestyle choices may drive these sex-based differences in the generation of TMAO.
By: Abdul Hafi Parimoo