Bidirectional relationship between statins and the gut microbiota: implications for cardiovascular health, diabetes, and cancer.

Abstract

Statins, which inhibit HMG-CoA reductase, are widely prescribed for cardiovascular disease prevention, while the gut microbiota plays a key role in host metabolism, immune regulation, and drug response.This narrative review examines how statins modulate the composition and function of the gut microbiota and, conversely, how the gut microbiota influences the pharmacokinetics, efficacy, and adverse effects of statins.Preclinical and clinical studies indicate that individual statins exert distinct effects; however, detailed understanding remains limited because these drugs are frequently evaluated collectively as a class rather than as separate compounds.Statins have been shown to alter microbial diversity and their metabolite profiles, which may enhance lipid-lowering effects and confer additional benefits such as anticancer activity, but may also contribute to adverse effects such as increased risk of type 2 diabetes. On the other hand, gut microbes modulate the bioavailability of statins by metabolizing the active compounds, which affects the therapeutic response.These results highlight the clinical importance of the gut microbiota in shaping the efficacy and safety profiles of statins and support the development of personalized, microbiome-informed treatment strategies.