The role of the gut microbiota in the development of coronary artery atherosclerosis

Cardiovascular diseases are one of the most common causes of death in the Russian Federation and worldwide. Consistently high statistical values, despite known risk factors, encourage us to look for new aspects of the etiology, pathogenesis and course of this group of diseases. The group of coronary heart disease requires special attention, most of the nosologies of which are diseases associated with atherosclerotic lesions of the coronary arteries. Despite the well-established concept of the pathogenesis of atherosclerosis associated with the response to endothelial damage, there is more and more data on the participation of gut microbiota metabolites in the occurrence and progression of this process, which has formed into the theory of atherogenic microbiome. The main bacterial factors influencing the pathogenesis of atherosclerosis are considered to be such metabolites as trimethylamine-N-oxide, lipopolysaccharide, short-chain fatty acids, and deoxyribonucleic acid. They take part in changes in lipid metabolism and immunological reactivity of the macroorganism, induce low-grade inflammation, which leads to the progression of atherosclerotic lesions of arteries, including coronary arteries. The purpose of this review is to analyze the literature on the role of the gut microbiota in the pathogenesis of coronary artery atherosclerosis, its effect on lipid metabolism, the relationship between changes in the microbiome and the development of atherosclerotic vascular lesions, and features of the atherogenic microbiome. Literature search was carried out in PubMed and Google Scholar systems among full-text articles published in Russian and English until January 2023 for the keywords: atherosclerosis, gut microbiota, cardiovascular diseases.