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Your gut has something to tell you.

Smart, actionable insights to improve your gut health. Learn more.

What is cardiovascular disease?

Cardiovascular disease (CVD) is a term encompassing a group of conditions affecting the heart or blood vessels. Together, CVDs – including coronary heart disease (CHD), stroke, high blood pressure, and heart failure – are the leading cause of death and disability worldwide, causing over 17 million deaths per year.1 CVDs are also the leading cause of death in the United States, causing around 1 million deaths annually.2

What are the symptoms?

Usually, patients experience no symptoms as the disease develops. As a result, CVDs can be asymptomatic for long periods of time, taking years or even decades to manifest. A stroke or heart attack can be the first sign of underlying CVD.1

The following symptoms are the most common1:

  • Cold sweats
  • Dyspnea (shortness of breath)
  • Nausea and fatigue
  • Pain or sensation of pressure in the chest, indicating angina
  • Pain or discomfort in the arms, left shoulder, elbows, jaw, or back
  • Temporary loss of consciousness

 What are the causes?

CVDs are complex, multifactorial diseases. However, the most frequent cause of CVD is atherosclerosis, in which the accumulation of lipid material in arteries’ inner walls makes the vessels more narrow and rigid.3

According to the Global Atlas on Cardiovascular Disease Prevention and Control, the main risk factors for CVDs are1:


  • Alcohol abuse
  • Sedentary lifestyle
  • Smoking
  • An unhealthy diet rich in salt, fat, and calories


  • Hypercholesterolemia
  • Hyperglycemia/diabetes
  • Hypertension
  • Overweight/obesity


  • Advancing age
  • Depression
  • Gender
  • Genetic susceptibility
  • Poverty and low educational status
  • Stress

How does this topic relate to my microbiome?

Some studies associate CVDs with changes in the abundance of certain microbes in the gut microbiome. For example, in patients with symptomatic atherosclerosis, populations of Collinsella increase, while Roseburia decreases.4 Overall gut microbial diversity also decreases in people with CVD.5

A diet rich in eggs and red meat provides the gut microbiota with phosphatidylcholine, choline, carnitine, and betaine,6 which the microbiota uses then to produce the metabolite trimethylamine (TMA)7,8. TMA itself can be only produced by the microbiota and not by the human body. It subsequently can be metabolized in the liver by human enzymes into trimethylamine N-oxide (TMAO). TMA and its derivate TMAO promote atherosclerosis and inflammation in animal models9 and have been found to predict CVD risk in humans.10,11 Recent studies are starting to show more insights into which gut bacteria can form TMA out of dietary components9. Higher TMAO levels in blood are associated with the consumption of a meat-rich diet. In contrast, vegans and vegetarians appear to have lower TMAO levels and fewer bacteria in their guts that can convert carnitine into TMA7.

Trimethylamine (TMA) is a chemical compound produced by the microbiota in different parts of the body (especially in the gut) that is associated with the production of atherosclerosis plaques.

Which diseases/topics are related to cardiovascular disease?

There are other conditions or diseases related to cardiovascular disease. These include:

Cardiovascular disease can also occur alongside other conditions. According to their frequency, these are 12:

  • Hypertension
  • Hyperlipidemia
  • Diabetes
  • Arthritis
  • Anemia
  • Heart failure
  • Chronic kidney disease
  • Cataracts
  • Chronic obstructive pulmonary disease
  • Atrial fibrillation

How can I take action?

It is advisable that you check your blood pressure, routinely. You should consult your healthcare provider if you experience some common symptoms.

Changes in lifestyle are effective in both, lowering high blood pressure and preventing hypertension and its consequences. It is advisable that you follow these recommendations12,13 :

  • Consume a healthy diet (decreasing salt, sugar, meat, and fats; increasing plant-based products; supplementing with probiotics and prebiotics).
  • Consume alcohol in moderation
  • Increase physical activity
  • Quit smoking
  • Control your weight


1. Mendis, S., Puska, P., Norrving, B., World Health Organization, World Heart Federation et al. (2011). Global Atlas on Cardiovascular Disease Prevention and Control. Geneva: World Health Organization.

2. Benjamin, E. J., et al. (2018). Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation, 137(12), e67–e492.

3. Rafieian-Kopaei, M., Setorki, M., Doudi, M., Baradaran, A., & Nasri, H. (2014). Atherosclerosis: process, indicators, risk factors and new hopes. International Journal of Preventive Medicine, 5(8), 927–946.

4. Karlsson, F. H., et al. (2012). Symptomatic atherosclerosis is associated with an altered gut metagenome. Nature Communications, 3, 1245.

5. Kelly, T. N., et al. (2016). Gut Microbiome Associates With Lifetime Cardiovascular Disease Risk Profile Among Bogalusa Heart Study Participants. Circulation Research, 119(8), 956–964.

6. Tang, W. H. W., & Hazen, S. L. (2014). The contributory role of gut microbiota in cardiovascular disease. Journal of Clinical Investigation, 124(10), 4204–4211.

7. Koeth, R. A., et al. (2013). Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nature Medicine, 19(5), 576–585.

8. Tang, W. H. W., et al. (2013). Intestinal Microbial Metabolism of Phosphatidylcholine and Cardiovascular Risk. New England Journal of Medicine, 368(17), 1575–1584.

9. Rath, S., Heidrich, B., Pieper, D. H., & Vital, M. (2017). Uncovering the trimethylamine-producing bacteria of the human gut microbiota. Microbiome, 5(1), 54.

10. Wang, Z., et al. (2011). Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature, 472(7341), 57–63.

11. Randrianarisoa, E., et al. (2016). Relationship of Serum Trimethylamine N-Oxide (TMAO) Levels with early Atherosclerosis in Humans. Scientific Reports, 6(1), 26745.

12. Arnett, D. K., Goodman, R. A., Halperin, J. L., Anderson, J. L., Parekh, A. K., & Zoghbi, W. A. (2014). AHA/ACC/HHS Strategies to Enhance Application of Clinical Practice Guidelines in Patients With Cardiovascular Disease and Comorbid Conditions. Journal of the American College of Cardiology, 64(17), 1851–1856.

13. World Health Organization. (‎2007)‎. Prevention of cardiovascular disease: guidelines for assessment and management of total cardiovascular risk. Geneva World Health Organization.