The human body has trillions of microorganisms, and together they shape an intuitively biological system within and without the exterior world. Changes and interactions in this ecosystem affect health and disease in the human body. The associated microflora in the host is called the microbiome. The digestive tract, specifically the large intestine, contains most of the microflora that exist in the human body. The gut microbiota plays a major role in maintaining nutrition and the immune system, which, in turn, affects the host’s susceptibility and response to pathologic conditions. Several illnesses, such as GI disorders, asthma, allergies, Central Nervous System Disorders, Metabolic Syndromes, Cancer, and Cardiovascular Diseases, are linked to an imbalance in the intestinal microbiome, called gut dysbiosis (2,3). CVD has become the leading cause of death worldwide due to the significant increase in incidence over the last few decades. This is particularly evident in high and middle-income countries. Due to the intricate nature of cardiovascular diseases and the lack of understanding of their underlying mechanisms, preventive measures cannot be developed (4). An unhealthy diet has long been regarded as an important cause of cardiovascular disease. The impact of genetic variation on body mass index and body fat distribution is significant, but it is believed to have an unexplained influence on the extent of variation in obesity among individuals (5,6). The role of dietary components in the microbiota and the metabolites involved in them is only recently discovered as important for cardiovascular health. Researchers are increasingly interested in the potential role of probiotics in preventing cardiovascular diseases and atherosclerosis, as they understand the significance of the gut microbiome in this area(6,7). While the impact of changes in microbiome composition related to CHD or atherosclerosis is still poorly understood, there is mounting evidence to back up this connection (7). Several cardiovascular risk factors may be influenced by functional dietary choices. However, little is known about the role of probiotics as important dietary components in the prevention and treatment of cardiovascular disease (8). Therefore, the purpose of this review is to discuss the role of probiotics in the management of CVD risk factors.

Coronary artery disease, stroke, hypertension, cardiomyopathy (infection), heart disease, or blood vessel blockage are among the most common cardiovascular diseases. CVD is a growing global health problem(9–11). In 2015, cardiovascular disease accounted for 18 million deaths, accounting for about a third of all deaths, up 12.5% from 2005. The American Heart Association reports that 92.1 million adults in the United States currently have cardiovascular disease. Approximately 43.9% of the total US population is projected to have CVD by 2030 (12). Atherosclerosis is a chronic inflammation caused by the accumulation and development of atherosclerotic plaques in arterial walls. It is controlled by these factors. Atherosclerosis is a major risk factor for stroke and heart attack. Several immune-mediated mechanisms are involved in the onset and progression of the disease (13). Risk factors for cardiovascular disease include genetics and unhealthy lifestyle choices such as poor exercise, bad diet, smoking habits, and drinking. Hypertension is the most common modifiable risk factor for cardiovascular disease (14,15). The presence of high blood cholesterol levels is often linked to a metabolic disorder that damages blood vessels and causes atherosclerosis, similar to type 2 diabetes. Atherosclerosis can be caused by the dysfunction of endothelial dysfunction in the renin–angiotensin–aldosterone system and at high levels due to hypertension and hypercholesterolemia (16,17).

The presence of probiotics is attributed to various beneficial microorganisms. Most of them belong to lactic acid bacteria such as Lactobacillus, Bifidobacterium, Lactococcus, Streptococcus and Enterococcus. The yeast genus Saccharomyces is also one of the known probiotics (28). Currently, the main sources of probiotic strains are humans and fermented foods like yogurt, kefir, sauerkraut, and kimchi. These foods are all consumed in their natural state. In clinical trials, there are several criteria based on which it is evaluated whether probiotics can be used in food. These criteria are (1) proper identification, characterization, and preservation of probiotic strains; (2) to sustain the studied probiotics; and (3) to ensure that they are alive at the study site. In addition, according to the WHO, the number of living microorganisms in foods containing probiotics for human consumption should be more than 106 cells/ml or cells/g, and the therapeutic dose in a clinical trial is 108-109 cells/ml or cells/g (29). Strong evidence shows that probiotics benefit human health and play an important role in the prevention of various diseases (30). Probiotic consumption can cross directly into the GIT and has been reported to be effective in the treatment of various types of diarrhea, especially traveler’s diarrhea, antibiotic-induced diarrhea, rotavirus diarrhea in infants, and inflammatory bowel disease (IBD) suppressing the activity of pathogenic intestinal microbes and promoting the correct balance between pathogens and commensal bacteria necessary for the normal functioning of the intestine (31). Probiotics’ ability to prevent disease or promote human health is primarily attributed to their interactions with pathogenic microorganisms, antagonizing pathogens and altering the intestinal microbiome, as well as modulating the host immune response (30) . Although the therapeutic benefits of traditional probiotics have been extensively researched, recent research has suggested that they could be next-generation proniotes produced by the gut microbiota for example, Bacteroides fragilis exerts anticancer effects and suppresses inflammation, Faecalibacterium prausnitzii protects mice against intestinal diseases, and Prevotella copri and Christensenella minuta play a role in controlling insulin resistance (32).

Sánchez et al. Proposed four distinct processes that aid in the advantageous properties of probiotics for human well-being include enhanced epithelial barrier function, competition with pathogen toxins for nutrients and attachment sites, immune system effects and neurotransmitter production on other tissues, and immunomodulation (33). The mechanisms underlying probiotics in cardiovascular disease are relatively complex and have not yet been elucidated. The mechanisms by which probiotics prevent cardiovascular disease, restore gut microbiota dysbiosis, and reduce anti-inflammatory responses are likely to be beneficial, but reducing oxidative stress, hypercholesterolemia, or high blood pressure also may be helpful (34).

Many studies have investigated the health benefits of probiotics for host populations. A range of conditions, including irritable colon syndrome, urinary tract infections, and symptoms of cold and flu, can be treated with probiotics. The matter is still being investigated. Probiotics may help treat metabolic disorders such as obesity, diabetes, and cardiovascular disease, according to growing evidence. Probiotic bacteria have been shown to protect against cardiovascular disease by reducing cholesterol levels, reducing oxidative stress, balancing functional and structural changes in gut microbiota, and increasing the immune response. Scientific literature shows that regular intake of probiotics, which improve the balance of gut microbiota and are beneficial for cardiovascular health due to their ability to decrease oxidation stress, has been shown to be beneficial in this area. Although there are still many unanswered questions and conflicting results, it is clear that consumption of probiotics can be a promising complement to more conventional cardiovascular therapy as well as other pharmacological measures commonly used to prevent the development or progression of CVD. Moreover, in order to maximise the potential beneficial effects of probiotics in any given situation, it will be necessary to increase knowledge of the different strains of bacteria present in them and how they should be consumed. Research on the gut microbiota, which generates enzymes, peptides, and biochemical pathways that differ from the host’s resources, can offer innovative avenues for developing drugs to treat cardiovascular diseases.