Atherosclerosis: Progression, risk factors, diagnosis, treatment, probiotics and synbiotics as a new prophylactic hope

Cardiovascular disease represents a significant public health challenge globally, being the foremost cause of morbidity and mortality, primarily due to atherosclerosis that occurs from the deposition of fats and fibrous elements in the walls of the artery. Approximately 90 % of cardiovascular diseases are potentially due to lifestyle-related factors such as high cholesterol, stress, high blood pressure, diabetes, and diet highlighting the importance of maintaining a healthy lifestyle. Normally, atherosclerosis is treated with statins but due to some adverse effects such as muscle pain, neuropathy, fatigue, gastrointestinal discomfort, and neurocognitive symptoms, the interest of scientists has shifted towards the use of natural interventions with conventional prophylactic agents such as phytochemicals, nutraceuticals, probiotics, and synbiotics. Among these, probiotics are considered a promising candidate due to their anti-inflammatory, anti-oxidative, immunomodulatory, and ameliorating microbiome dysbiosis in various diseases. Additionally, the combination of probiotics with prebiotics referred to as synbiotics may augment the anti-atherosclerotic potential as prebiotics enhance both the growth and metabolic processes of the probiotics. Therefore, an attempt has been made to provide insight into the detailed information on atherosclerosis, i.e., epidemiology, pathophysiology, risk factors, and diagnosis, emphasizing the prophylactic modulatory mechanisms of probiotics and synbiotics.