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The gut microbiota, a diverse community of microorganisms residing in the gastrointestinal tract, interacts with its host through metabolites, immune modulation, and systemic signaling pathways, collectively shaping cardiovascular physiology. Dysbiosis, or an imbalance in gut microbial composition, has been linked to various cardiovascular diseases (CVDs), including hypertension, heart failure and atherosclerosis. Key microbial metabolites such as short\u2010chain fatty acids (SCFAs), trimethylamine N\u2010oxide (TMAO) and lipopolysaccharides (LPS) have been implicated in mechanisms involving endothelial, cardiac fibroblast, cardiomyocyte dysfunction, systemic inflammation, and metabolic dysregulation. This review explores the dynamic interplay between the gut and the heart, focusing on: gut microbiota composition and its alterations in CVD; microbial\u2010derived metabolites and their mechanistic roles in cardiovascular pathophysiology; pathways linking gut dysbiosis to endothelial, cardiac fibroblast and cardiomyocyte dysfunction, inflammation, and immune responses; and therapeutic opportunities targeting the gut\u2010heart axis, including dietary interventions, prebiotics, probiotics and emerging microbiota\u2010based strategies. By unraveling these intricate relationships, we aim to provide a comprehensive understanding of how gut microbiota shape CVD pathophysiology and discuss potential avenues for novel therapeutics in precision medicine.<\/jats:p>","DOI":"10.1002\/cph4.70024","type":"journal-article","created":{"date-parts":[[2025,6,21]],"date-time":"2025-06-21T03:04:32Z","timestamp":1750475072000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Microbiota in Gut\u2010Heart Axis: Metabolites and Mechanisms in Cardiovascular Disease"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9389-6181","authenticated-orcid":false,"given":"Narendra","family":"Kondapalli","sequence":"first","affiliation":[{"name":"The University of Toledo College of Medicine and Life Sciences  Toledo Ohio 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