Advances in Research

Cardiovascular disease (CVD) remains closely associated with dyslipidaemia, inflammation, oxidative stress, insulin resistance and altered gut microbiota. Gut dysbiosis may affect cardiovascular risk through increased intestinal permeability, translocation of lipopolysaccharide, altered bile acid metabolism, production of trimethylamine-N-oxide (TMAO) and changes in short-chain fatty acid (SCFA) synthesis. This review summarises evidence on the role of symbiotics, as combinations of probiotics and prebiotics, in the management of CVD and related cardiometabolic risk factors. A literature search was conducted using PubMed, Google Scholar, Research Scholar, and backward and forward citation searching. Peer-reviewed English-language systematic reviews, original research articles, clinical trials and meta-analyses were considered. The manuscript also examines evidence relating to atherosclerosis, diabetes-associated cardiovascular risk and TMAO-mediated mechanisms. The reviewed evidence indicates that symbiotic supplementation may improve selected lipid parameters, including total cholesterol, LDL-C, triglycerides and HDL-C, although effects were not uniform across studies. Some animal and clinical studies also reported improvements in inflammatory markers, oxidative stress biomarkers, nitric oxide availability, blood pressure-related outcomes, insulin sensitivity and gut microbial composition. Several studies further suggest that modulation of gut microbiota may influence gut-derived metabolites, particularly by reducing circulating TMAO and supporting SCFA production, thereby potentially contributing to intestinal barrier integrity and metabolic regulation. However, responses varied according to probiotic strains, prebiotic substrates, study populations, intervention duration and baseline metabolic status. Overall, the manuscript indicates that symbiotics may represent a supportive dietary approach for improving cardiovascular risk profiles through gut microbiota modulation. Further well-designed clinical studies are required to clarify strain-specific effects, optimal dosage, intervention duration and long-term cardiovascular relevance.