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The foods we eat, coupled with our physiology and exposures (eg, antibiotics, supplements), directly contribute to atherosclerotic disease in complex ways that are mediated by gastrointestinal flora and metabolic by\u2010products. Proliferation of \u201cpathogenic\u201d gut microbes such as\n            <jats:italic>Enterobacteriaceae<\/jats:italic>\n            and\n            <jats:italic>Streptococcus<\/jats:italic>\n            spp, decrement of \u201ccommensal\u201d species such as\n            <jats:italic>Akkermansia<\/jats:italic>\n            spp and the biodiversity of gut flora are directly related to an individual's dietary intake and exposure history. Each of these components of the gut microbiome correlate with the development or progression of many conditions including atherosclerosis. Moreover, the metabolism of certain substrates found in animal products (notably\n            <jats:sc>l<\/jats:sc>\n            \u2010carnitine and choline) and of refined sugars by these microorganisms leads to buildup of circulating metabolites with known links to atherogenesis, platelet activation, atrial fibrillation, and other adverse vascular outcomes. Several of these toxic metabolites, including trimethylamine and trimethylamine N\u2010oxide, have been extensively studied in cardiovascular and cerebrovascular disease. Trimethylamine and trimethylamine N\u2010oxide represent not only biomarkers of gut dysbiosis and cardiovascular risk, but they are increasingly recognized as therapeutic targets for novel interventions in atherosclerotic vascular disease. The individualized targeting of one's microbiome, and perhaps more generalized targeting of toxic microbial metabolites, has the potential to revolutionize the treatment of vascular disease. In this review, we summarize the latest evidence illustrating the impact of the microbiome on cerebrovascular disease and highlight the potential applications of this information on individualized and global scales.\n          <\/jats:p>","DOI":"10.1161\/svin.124.001272","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T11:56:57Z","timestamp":1718884617000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Understanding the Relationship Between Cerebrovascular Disease and the Gut Microbiome"],"prefix":"10.1161","volume":"5","author":[{"given":"William","family":"Roth","sequence":"first","affiliation":[{"name":"Department of Neurology University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elaine","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orlando","family":"De Leon","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sajid","family":"Suriya","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farima","family":"Fakhri","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James R.","family":"Brorson","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Polster","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tareq","family":"Kass\u2010Hout","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyam","family":"Prabhakaran","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0287-3967","authenticated-orcid":false,"given":"James E.","family":"Siegler","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Chicago Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1161\/STROKEAHA.112.651059","article-title":"Traditional cardiovascular risk factors explain the minority of the variability in carotid plaque","volume":"43","author":"Kuo F","year":"2012","unstructured":"Kuo F, Gardener H, Dong C, Cabral D, Della\u2010Morte D, Blanton SH, Elkind MSV, Sacco RL, Rundek T. 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