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This review systematically clarifies the causal relationship between gut dysbiosis and the pathogenesis of cardiovascular diseases CVD), moving beyond epidemiological associations to solid causal evidence from preclinical and clinical studies. We focus on dissecting the pathophysiological mechanisms of key microbiota-derived metabolites, including trimethylamine N-oxide, short-chain fatty acids, phenylacetylglutamine, and secondary bile acids, and elaborate on their specific regulatory pathways in the development of atherosclerosis, hypertension, heart failure, and thrombosis. 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