Probiotics in atherosclerosis: mechanisms, efficacy and future directions - a review study.

Background: Atherosclerosis (AS), the pathological basis of cardiovascular diseases, is a major cause of global mortality. Gut microbiota dysbiosis contributes to AS progression via trimethylamine N-oxide (TMAO), inflammation, and vascular dysfunction. Probiotics have emerged as a potential strategy against AS. Objective: To systematically review the mechanisms, efficacy, and future perspectives of probiotics in atherosclerosis. Methods: Preclinical and clinical evidence was summarized, focusing on gut microbiota, TMAO, short-chain fatty acids, lipid metabolism, inflammation, and vascular function. Results: Probiotics exert anti-atherosclerotic effects by restoring gut microbiota composition, reducing TMAO, increasing short-chain fatty acids, improving lipid profiles, alleviating inflammation, and protecting endothelial function. Clinical trials support beneficial effects on metabolic and vascular risk factors but are limited by small sample sizes and short durations. Conclusions: Probiotics are a promising and safe approach for AS intervention. Future large-scale, long-term trials and optimized probiotic designs are required to facilitate clinical application.