A new review published in the journal npj Biofilms and Microbiomes suggests that the recovery from a heart attack may be shaped by signals from gut microbes, which can affect inflammation, scarring, and healing through epigenetic mechanisms, according to an April 6 article.
The findings highlight the growing interest in how factors beyond traditional cardiovascular risks could play a role in heart health. Researchers are increasingly looking at the gut microbiome as a potential contributor to outcomes after myocardial infarction (MI), commonly known as a heart attack.
The review describes how metabolites produced by gut bacteria—including short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO)—can influence inflammation and metabolic processes. These effects are partly mediated through epigenetic changes such as DNA methylation and histone modification, which control gene activity without altering genetic sequences. The authors note that this regulatory axis may help explain why some patients recover better than others after MI.
During health, beneficial gut microbes produce SCFAs that reduce inflammation and protect tissues. However, following a heart attack or with underlying dysbiosis—an imbalance of gut bacteria—levels of harmful substances like TMAO increase while protective SCFAs decrease. This shift is linked to greater inflammation and more severe cardiac injury.
Epigenetics provides one explanation for these effects: abnormal DNA methylation patterns during MI can activate inflammatory genes while suppressing those that protect the heart. Some microbial metabolites can further modulate these patterns or alter histone structure to impact gene expression related to healing or scarring. Non-coding RNAs regulated by microbial signals also play roles in shaping cardiac responses after injury.
Therapies targeting this connection are being explored, including high-fiber diets to boost beneficial metabolites, drugs mimicking their effects on gene regulation, probiotics or fecal microbiota transplantation to restore balance, and postbiotics as controlled alternatives. However, challenges remain due to individual differences in response and limited clinical evidence so far.
The review concludes that myocardial infarction should be seen not just as a cardiovascular event but also as influenced by systemic factors like the gut microbiome interacting with genetic regulation. Future therapies addressing both areas could offer new ways of preventing or treating heart disease.
