{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:04:49Z","timestamp":1790139889946,"version":"4.0.1"},"reference-count":123,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The gut microbiota is increasingly recognized as an important modulator of cardiovascular health, demonstrating complicated interactions among diet, metabolism, immunology and host physiology. Evidence is accumulating that changes in the composition and function of the gut microbiome may contribute to the pathogenesis of atherosclerosis, hypertension, heart failure, thrombosis and other cardiovascular phenotypes through mechanisms involving microbial metabolites, intestinal barrier dysfunction, inflammation and metabolic dysregulation. In this context, the key question of this narrative review is: how far can modulation of the gut microbiome and its metabolic functions be a clinically meaningful approach in the prevention and treatment of cardiovascular disease, and which of the currently available microbiome-targeted approaches have sufficient mechanistic and clinical evidence to justify translation into cardiovascular practice? To answer this question, we review the evidence linking the gut microbiome to major cardiovascular phenotypes, such as atherosclerosis, hypertension, heart failure, thrombosis and atrial fibrillation, with particular focus on the mechanisms through which microbial metabolites, intestinal barrier dysfunction, inflammation and metabolic dysregulation may affect cardiovascular risk. We then review current and emerging strategies for microbiome modulation, including dietary interventions, prebiotics, probiotics, synbiotics, postbiotics, fecal microbiota transplantation and targeted inhibition of microbial metabolic pathways such as trimethylamine (TMA)\/trimethylamine N-oxide (TMAO) production. We also examine bidirectional interactions between cardiovascular drugs and gut microbiome and the role of these interactions in the development of precision methods to cardiovascular prevention and treatment. Finally, we outline the major limitations of the current evidence and highlight goals for future mechanistic, translational and clinical research.<\/jats:p>","DOI":"10.3390\/nu18183091","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3091","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Targeting the Gut Microbiome in Cardiovascular Disease: Current Therapeutic Strategies and Future Perspectives"],"prefix":"10.3390","volume":"18","author":[{"given":"Diana Elena","family":"David","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cringuta Mariana","family":"Paraschiv","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Elisabeta","family":"Checherita","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2497-9236","authenticated-orcid":false,"given":"Stefan Andrei","family":"Chiriac","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela Raluca","family":"Grigorasi","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2640-8795","authenticated-orcid":false,"given":"Vasile Valeriu","family":"Lupu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8147-3632","authenticated-orcid":false,"given":"Ancuta","family":"Lupu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard Iosif","family":"Pertea","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Paduraru","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca","family":"Adam Raileanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Tataranu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2791-5165","authenticated-orcid":false,"given":"Oana-Raluca","family":"Temneanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3958-8671","authenticated-orcid":false,"given":"Tatiana","family":"Dramba","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana-Maria","family":"Casapu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina Mihaela","family":"Esanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025). Cardiovascular Diseases (CVDs), World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s43556-022-00091-2","article-title":"The role of the gut microbiota in health and cardiovascular diseases","volume":"3","author":"Wang","year":"2022","journal-title":"Mol. Biomed."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/CRD.0000000000000701","article-title":"The interplay of microbiome dysbiosis and cardiovascular disease","volume":"34","author":"Zaher","year":"2026","journal-title":"Cardiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1042\/BCJ20160510","article-title":"Introduction to the human gut microbiota","volume":"474","author":"Thursby","year":"2017","journal-title":"Biochem. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"R37","DOI":"10.1530\/JOE-13-0131","article-title":"The gut microbiome: The role of a virtual organ in the endocrinology of the host","volume":"218","author":"Evans","year":"2013","journal-title":"J. Endocrinol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1038\/s41579-020-0433-9","article-title":"Gut microbiota in human metabolic health and disease","volume":"19","author":"Fan","year":"2021","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2174\/011871529X310857240607103028","article-title":"Mechanistic Review on the Role of Gut Microbiota in the Pathology of Cardiovascular Diseases","volume":"24","author":"Usman","year":"2024","journal-title":"Cardiovasc. Hematol. Disord. Drug Targets"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3892\/etm.2024.12716","article-title":"Gut microbiota: Implications in pathogenesis and therapy to cardiovascular disease (Review)","volume":"28","author":"Lin","year":"2024","journal-title":"Exp. Ther. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1016\/j.jacc.2019.03.024","article-title":"Intestinal Microbiota in Cardiovascular Health and Disease: JACC State-of-the-Art Review","volume":"73","author":"Tang","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1016\/j.cell.2024.03.014","article-title":"Gut microbiome and metabolome profiling in Framingham heart study reveals cholesterol-metabolizing bacteria","volume":"187","author":"Li","year":"2024","journal-title":"Cell"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Martins, D., Silva, C., Ferreira, A.C., Dourado, S., Albuquerque, A., Saraiva, F., Batista, A.B., Castro, P., Leite-Moreira, A., and Barros, A.S. (2024). Unravelling the Gut Microbiome Role in Cardiovascular Disease: A Systematic Review and a Meta-Analysis. Biomolecules, 14.","DOI":"10.3390\/biom14060731"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/nature09922","article-title":"Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease","volume":"472","author":"Wang","year":"2011","journal-title":"Nature"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1038\/nm.3145","article-title":"Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis","volume":"19","author":"Koeth","year":"2013","journal-title":"Nat. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1038\/s41579-025-01183-w","article-title":"Gut microbiota-derived short-chain fatty acids and their role in human health and disease","volume":"23","author":"Mukhopadhya","year":"2025","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1038\/s41392-024-01811-6","article-title":"Bile acid metabolism and signaling in health and disease: Molecular mechanisms and therapeutic targets","volume":"9","author":"Fleishman","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chen, F., and Gong, L. (2025). Bile acid\u2013microbiota interactions in cardiometabolic diseases: Mechanisms and emerging therapeutic approaches. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1689026"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.2337\/db06-1491","article-title":"Metabolic endotoxemia initiates obesity and insulin resistance","volume":"56","author":"Cani","year":"2007","journal-title":"Diabetes"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E746","DOI":"10.1152\/ajpendo.00355.2025","article-title":"Gut-derived lipopolysaccharides and metabolic endotoxemia: A critical review","volume":"329","author":"Chen","year":"2025","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.1161\/HYP.0000000000000247","article-title":"Hypertension and the Gut Microbiome: A Science Advisory From the American Heart Association","volume":"82","author":"Yang","year":"2025","journal-title":"Hypertension"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1007\/s10741-025-10546-7","article-title":"The role of the gut microbiota and metabolites in heart failure and possible implications for treatment","volume":"30","author":"Shoukry","year":"2025","journal-title":"Heart Fail. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1038\/s41569-024-01070-6","article-title":"The gut microbiota in thrombosis","volume":"22","author":"Khuu","year":"2025","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Human Microbiome Project Consortium (2012). Structure, function and diversity of the healthy human microbiome. Nature, 486, 207\u2013214.","DOI":"10.1038\/nature11234"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1038\/s41392-022-00974-4","article-title":"Microbiota in health and diseases","volume":"7","author":"Hou","year":"2022","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1136\/gutjnl-2019-318427","article-title":"Leaky gut: Mechanisms, measurement and clinical implications in humans","volume":"68","author":"Camilleri","year":"2019","journal-title":"Gut"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1002\/j.2040-4603.2013.tb00517.x","article-title":"Bile acid metabolism and signaling","volume":"3","author":"Chiang","year":"2013","journal-title":"Compr. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1038\/nri.2017.7","article-title":"Dysbiosis and the immune system","volume":"17","author":"Levy","year":"2017","journal-title":"Nat. Rev. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.cell.2014.03.011","article-title":"Role of the microbiota in immunity and inflammation","volume":"157","author":"Belkaid","year":"2014","journal-title":"Cell"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.mib.2018.07.003","article-title":"Low diversity gut microbiota dysbiosis: Drivers, functional implications and recovery","volume":"44","author":"Kriss","year":"2018","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1111\/cmi.12308","article-title":"Defining dysbiosis and its influence on host immunity and disease","volume":"16","author":"Petersen","year":"2014","journal-title":"Cell. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e70168","DOI":"10.1002\/mco2.70168","article-title":"Gut Microbiota Dysbiosis: Pathogenesis, Diseases, Prevention, and Therapy","volume":"6","author":"Shen","year":"2025","journal-title":"MedComm"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Acevedo-Rom\u00e1n, A., Pag\u00e1n-Zayas, N., Vel\u00e1zquez-Rivera, L.I., Torres-Ventura, A.C., and Godoy-Vitorino, F. (2024). Insights into Gut Dysbiosis: Inflammatory Diseases, Obesity, and Restoration Approaches. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25179715"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Safarchi, A., Al-Qadami, G., Tran, C.D., and Conlon, M. (2025). Understanding Dysbiosis and Resilience in the Human Gut Microbiome: Biomarkers, Interventions, and Challenges. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1559521"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Clemente-Su\u00e1rez, V.J., Beltr\u00e1n-Velasco, A.I., Redondo-Fl\u00f3rez, L., Mart\u00edn-Rodr\u00edguez, A., and Tornero-Aguilera, J.F. (2023). Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review. Nutrients, 15.","DOI":"10.3390\/nu15122749"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"123541","DOI":"10.1016\/j.carbpol.2025.123541","article-title":"The Mutual Effect of Dietary Fiber and Polyphenol on Gut Microbiota: Implications for the Metabolic and Microbial Modulation and Associated Health Benefits","volume":"358","author":"Cheng","year":"2025","journal-title":"Carbohydr. Polym."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Du, Y., He, C., An, Y., Huang, Y., Zhang, H., Fu, W., Wang, M., Shan, Z., Xie, J., and Yang, Y. (2024). The Role of Short Chain Fatty Acids in Inflammation and Body Health. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25137379"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Dharmarathne, G., Kazi, S., King, S., and Jayasinghe, T.N. (2024). The Bidirectional Relationship between Cardiovascular Medications and Oral and Gut Microbiome Health: A Comprehensive Review. Microorganisms, 12.","DOI":"10.3390\/microorganisms12112246"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/MS9.0000000000002789","article-title":"The Gut\u2013Heart Axis: A Review of Gut Microbiota, Dysbiosis, and Cardiovascular Disease Development","volume":"87","author":"Abdulrahim","year":"2025","journal-title":"Ann. Med. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Zhu, G., and Man, J. (2026). Gut Microbiota-Derived Metabolites in Cardiovascular Disease: Mechanisms, Disease-Specific Roles, and Translational Opportunities. Front. Cardiovasc. Med., 13.","DOI":"10.3389\/fcvm.2026.1884283"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.cell.2016.02.011","article-title":"Gut Microbial Metabolite TMAO Enhances Platelet Hyperreactivity and Thrombosis Risk","volume":"165","author":"Zhu","year":"2016","journal-title":"Cell"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1093\/ajcn\/nqac074","article-title":"Gut microbiota\u2013derived metabolite trimethylamine-N-oxide and multiple health outcomes: An umbrella review and updated meta-analysis","volume":"116","author":"Li","year":"2022","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1038\/s41422-023-00914-z","article-title":"Molecular recognition and activation mechanism of short-chain fatty acid receptors FFAR2\/3","volume":"34","author":"Li","year":"2024","journal-title":"Cell Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.clnu.2022.10.024","article-title":"Butyrate\u2019s role in human health and the current progress towards its clinical application to treat gastrointestinal disease","volume":"42","author":"Hodgkinson","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Lu, Y., Zhang, Y., Zhao, X., Shang, C., Xiang, M., Li, L., and Cui, X. (2022). Microbiota-derived short-chain fatty acids: Implications for cardiovascular and metabolic disease. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.900381"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/S0140-6736(14)61933-4","article-title":"Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): A multicentre, randomised, placebo-controlled trial","volume":"385","author":"Loomba","year":"2015","journal-title":"Lancet"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.ajcnut.2023.08.023","article-title":"Gut microbiota-derived secondary bile acids, bile acids receptor polymorphisms, and risk of cardiovascular disease in individuals with newly diagnosed type 2 diabetes: A cohort study","volume":"119","author":"Lu","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2426610","DOI":"10.1080\/19490976.2024.2426610","article-title":"Gut microbial metabolism of bile acids modifies the effect of Mediterranean diet interventions on cardiometabolic risk in a randomized controlled trial","volume":"16","author":"Gao","year":"2024","journal-title":"Gut Microbes"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1038\/s41569-022-00737-2","article-title":"Gut-derived low-grade endotoxaemia, atherothrombosis and cardiovascular disease","volume":"20","author":"Violi","year":"2023","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1189\/jlb.3RU0316-151R","article-title":"Endotoxemia-menace, marker, or mistake?","volume":"100","author":"Munford","year":"2016","journal-title":"J. Leukoc. Biol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1161\/CIRCRESAHA.122.321253","article-title":"Gut Microbially Produced Indole-3-Propionic Acid Inhibits Atherosclerosis by Promoting Reverse Cholesterol Transport and Its Deficiency Is Causally Related to Atherosclerotic Cardiovascular Disease","volume":"131","author":"Xue","year":"2022","journal-title":"Circ. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.cell.2020.02.016","article-title":"A Cardiovascular Disease-Linked Gut Microbial Metabolite Acts via Adrenergic Receptors","volume":"180","author":"Nemet","year":"2020","journal-title":"Cell"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"173916","DOI":"10.1016\/j.ejphar.2021.173916","article-title":"Effects of gut microbiota on atherosclerosis through hydrogen sulfide","volume":"896","author":"Gui","year":"2021","journal-title":"Eur. J. Pharmacol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e002157","DOI":"10.1161\/CIRCGEN.118.002157","article-title":"Circulating Branched-Chain Amino Acids and Incident Cardiovascular Disease in a Prospective Cohort of US Women","volume":"11","author":"Tobias","year":"2018","journal-title":"Circ. Genom. Precis. Med."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Jiang, W., Lu, K., Zhuang, Z., Wang, X., Tang, X., Huang, T., Gao, P., Wang, Y., and Du, J. (2023). Mendelian Randomization Analysis Provides Insights into the Pathogenesis of Serum Levels of Branched-Chain Amino Acids in Cardiovascular Disease. Metabolites, 13.","DOI":"10.3390\/metabo13030403"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1038\/ncomms2266","article-title":"Symptomatic atherosclerosis is associated with an altered gut metagenome","volume":"3","author":"Karlsson","year":"2012","journal-title":"Nat. Commun."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11883-025-01371-2","article-title":"Gut Microbiota and Atherosclerosis: Integrative Multi-Omics and Mechanistic Insights","volume":"28","author":"He","year":"2025","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Yan, Q., Gu, Y., Li, X., Yang, W., Jia, L., Chen, C., Han, X., Huang, Y., Zhao, L., and Li, P. (2017). Alterations of the Gut Microbiome in Hypertension. Front. Cell. Infect. Microbiol., 7.","DOI":"10.3389\/fcimb.2017.00381"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1111\/jch.14722","article-title":"Gut microbiota changes in patients with hypertension: A systematic review and meta-analysis","volume":"25","author":"Cai","year":"2023","journal-title":"J. Clin. Hypertens."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ijcard.2021.06.003","article-title":"Metagenomic analysis of gut microbiota reveals its role in trimethylamine metabolism in heart failure","volume":"338","author":"Emoto","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1016\/j.jacc.2014.02.617","article-title":"Prognostic value of elevated levels of intestinal microbe-generated metabolite trimethylamine-N-oxide in patients with heart failure: Refining the gut hypothesis","volume":"64","author":"Tang","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1111\/joim.12328","article-title":"Microbiota-dependent metabolite trimethylamine-N-oxide is associated with disease severity and survival of patients with chronic heart failure","volume":"277","author":"Ueland","year":"2015","journal-title":"J. Intern. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"374","DOI":"10.5694\/mja2.50781","article-title":"Gut microbiota-derived trimethylamine N-oxide is associated with poor prognosis in patients with heart failure","volume":"213","author":"Li","year":"2020","journal-title":"Med. J. Aust."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e00071-20","DOI":"10.1128\/mSphere.00071-20","article-title":"Different Types of Atrial Fibrillation Share Patterns of Gut Microbiota Dysbiosis","volume":"5","author":"Zuo","year":"2020","journal-title":"mSphere"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Zuo, K., Liu, X., Wang, P., Jiao, J., Han, C., Liu, Z., Yin, X., Li, J., and Yang, X. (2020). Metagenomic data-mining reveals enrichment of trimethylamine-N-oxide synthesis in gut microbiome in atrial fibrillation patients. BMC Genom., 21.","DOI":"10.1186\/s12864-020-06944-w"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"9920016","DOI":"10.1155\/crp\/9920016","article-title":"The Gut-Heart Axis: A Comprehensive Review of Microbiota\u2019s Role in Cardiovascular Health and Disease and Emerging Therapeutic Strategies","volume":"2026","author":"Mylavarapu","year":"2026","journal-title":"Cardiol. Res. Pract."},{"key":"ref_66","first-page":"e107856","article-title":"Effects of Gut Microbiota-Modulating Interventions on Systemic Inflammation and Functional Outcomes in Established Cardiovascular Disease: A Systematic Review","volume":"18","author":"Ahmad","year":"2026","journal-title":"Cureus"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1038\/s41591-020-01223-3","article-title":"The gut microbiome modulates the protective association between a Mediterranean diet and cardiometabolic disease risk","volume":"27","author":"Wang","year":"2021","journal-title":"Nat. Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.ajcnut.2024.02.021","article-title":"Effect of 1-year lifestyle intervention with energy-reduced Mediterranean diet and physical activity promotion on the gut metabolome and microbiota: A randomized clinical trial","volume":"119","author":"Atzeni","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12937-024-01060-x","article-title":"The impact of dietary patterns on gut microbiota for the primary and secondary prevention of cardiovascular disease: A systematic review","volume":"24","author":"Yu","year":"2025","journal-title":"Nutr. J."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Shremo Msdi, A., Wang, E.M., and Garey, K.W. (2025). Prebiotics Improve Blood Pressure Control by Modulating Gut Microbiome Composition and Function: A Systematic Review and Meta-Analysis. Nutrients, 17.","DOI":"10.3390\/nu17152502"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.ajcnut.2023.10.030","article-title":"The effects of inulin-type fructans on cardiovascular disease risk factors: Systematic review and meta-analysis of randomized controlled trials","volume":"119","author":"Talukdar","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"da C. Pinaffi-Langley, A.C., Tarantini, S., Hord, N.G., and Yabluchanskiy, A. (2024). Polyphenol-Derived Microbiota Metabolites and Cardiovascular Health: A Concise Review of Human Studies. Antioxidants, 13.","DOI":"10.3390\/antiox13121552"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Cano, R., Berm\u00fadez, V., Galban, N., Garrido, B., Santeliz, R., Gotera, M.P., Duran, P., Boscan, A., Carbonell-Zabaleta, A.K., and Dur\u00e1n-Ag\u00fcero, S. (2024). Dietary Polyphenols and Gut Microbiota Cross-Talk: Molecular and Therapeutic Perspectives for Cardiometabolic Disease: A Narrative Review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25169118"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"100202","DOI":"10.1016\/j.foohum.2023.12.010","article-title":"The influence of food matrix on the stability and bioavailability of phytochemicals: A comprehensive review","volume":"2","author":"Mishra","year":"2024","journal-title":"Food Humanit."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2671724","DOI":"10.1080\/29933935.2026.2671724","article-title":"The food matrix as a confounder in diet\u2013microbiome studies: Methodological challenges and research gaps","volume":"3","author":"Solano","year":"2026","journal-title":"Gut Microbes Rep."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Sejbuk, M., Miro\u0144czuk-Chodakowska, I., Karav, S., and Witkowska, A.M. (2024). Dietary Polyphenols, Food Processing and Gut Microbiome: Recent Findings on Bioavailability, Bioactivity, and Gut Microbiome Interplay. Antioxidants, 13.","DOI":"10.3390\/antiox13101220"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"116199","DOI":"10.1016\/j.foodres.2025.116199","article-title":"Effect of starch structuring and processing on the bioaccessibility of polyphenols in starchy foodstuffs: A review","volume":"208","author":"Tovar","year":"2025","journal-title":"Food Res. Int."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1038\/nrgastro.2014.66","article-title":"Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic","volume":"11","author":"Hill","year":"2014","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"6576","DOI":"10.1007\/s12602-026-10944-9","article-title":"Modulating Gut Microbiota To Control Hypertension: A Systematic Review and Meta-Analysis of Probiotics, Postbiotics, Prebiotics and Synbiotics","volume":"18","author":"Aditya","year":"2026","journal-title":"Probiotics Antimicrob. Proteins"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1007\/s12602-024-10303-6","article-title":"Effects of Probiotics on Inflammatory Biomarkers and Its Associations With Cardiac Autonomic Function in Women With Arterial Hypertension: A Secondary Analysis of a Randomized Clinical Trial","volume":"17","author":"Maia","year":"2025","journal-title":"Probiotics Antimicrob. Proteins"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s11906-020-01080-y","article-title":"Efficacy of Probiotics in Patients of Cardiovascular Disease Risk: A Systematic Review and Meta-analysis","volume":"22","author":"Dixon","year":"2020","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Dong, J., Chen, L., Zheng, N., and Yang, M. (2025). The beneficial effects of probiotics on patients with coronary heart disease: A systematic review and meta-analysis. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1612021"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Yang, X., Yu, Y., Huang, X., Huang, J., Xiang, Q., and Yu, R. (2026). Effects of probiotics on lipid metabolism, oxidation, and inflammation in coronary heart disease: A systematic review and meta-analysis. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1681230"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"123981","DOI":"10.1016\/j.lfs.2025.123981","article-title":"The gut microbiota and cardiovascular disease: Exploring the role of microbial dysbiosis and metabolites in pathogenesis and therapeutics","volume":"381","author":"Mohsenzadeh","year":"2025","journal-title":"Life Sci."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1038\/nrgastro.2017.75","article-title":"Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics","volume":"14","author":"Gibson","year":"2017","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s40168-022-01307-x","article-title":"Microbiota responses to different prebiotics are conserved within individuals and associated with habitual fiber intake","volume":"10","author":"Holmes","year":"2022","journal-title":"Microbiome"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1146\/annurev-food-060721-015516","article-title":"Predicting Personalized Responses to Dietary Fiber Interventions: Opportunities for Modulation of the Gut Microbiome to Improve Health","volume":"14","author":"Kok","year":"2023","journal-title":"Annu. Rev. Food Sci. Technol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1038\/s41575-020-0344-2","article-title":"The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics","volume":"17","author":"Swanson","year":"2020","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Skonieczna-\u017bydecka, K., Ka\u017amierczak-Siedlecka, K., Kaczmarczyk, M., \u015aliwa-Dominiak, J., Maciejewska, D., Janda, K., Stachowska, E., \u0141oniewska, B., Malinowski, D., and Borecki, K. (2020). The Effect of Probiotics and Synbiotics on Risk Factors Associated with Cardiometabolic Diseases in Healthy People-A Systematic Review and Meta-Analysis with Meta-Regression of Randomized Controlled Trials. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061788"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1038\/s41575-021-00440-6","article-title":"The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics","volume":"18","author":"Salminen","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.tifs.2023.06.009","article-title":"Postbiotics: An overview of concepts, inactivation technologies, health effects, and driver trends","volume":"138","author":"Pimentel","year":"2023","journal-title":"Trends Food Sci. Technol."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Trymers, M., Wi\u015bniewski, P., Tkacz, K., and Zakrzewski, A. (2026). From Production to Application: Postbiotics in Meat, Meat Products, Other Food Matrices, and Bioactive Packaging. Foods, 15.","DOI":"10.3390\/foods15030501"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"107334","DOI":"10.1016\/j.phrs.2024.107334","article-title":"Microbiota alterations associated with vascular diseases: Postbiotics as a next-generation magic bullet for gut-vascular axis","volume":"207","author":"Flori","year":"2024","journal-title":"Pharmacol. Res."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"e87","DOI":"10.1016\/j.clinthera.2023.11.015","article-title":"The Effect of Fecal Microbiota Transplantation on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis","volume":"46","author":"Pakmehr","year":"2024","journal-title":"Clin. Ther."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"4612","DOI":"10.12998\/wjcc.v11.i19.4612","article-title":"Fecal microbiota transplantation in patients with metabolic syndrome and obesity: A randomized controlled trial","volume":"11","author":"Clemente","year":"2023","journal-title":"World J. Clin. Cases"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.chom.2023.03.020","article-title":"Key determinants of success in fecal microbiota transplantation: From microbiome to clinic","volume":"31","author":"Porcari","year":"2023","journal-title":"Cell Host Microbe"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"107584","DOI":"10.1016\/j.pharmthera.2020.107584","article-title":"Targeting the human microbiome and its metabolite TMAO in cardiovascular prevention and therapy","volume":"213","author":"Dannenberg","year":"2020","journal-title":"Pharmacol. Ther."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"936","DOI":"10.17305\/bb.2023.8893","article-title":"The roles of trimethylamine-N-oxide in atherosclerosis and its potential therapeutic aspect: A literature review","volume":"23","author":"Oktaviono","year":"2023","journal-title":"Biomol. Biomed."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1016\/j.cell.2015.11.055","article-title":"Non-lethal Inhibition of Gut Microbial Trimethylamine Production for the Treatment of Atherosclerosis","volume":"163","author":"Wang","year":"2015","journal-title":"Cell"},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Zhang, N., Wang, Y., Luo, G., and Gao, X. (2026). Gut Microbial Choline TMA-Lyase CutC: From Metabolic Mechanism to a Novel Therapeutic Target for Diseases. Nutrients, 18.","DOI":"10.3390\/nu18111659"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1038\/s41586-019-1291-3","article-title":"Mapping human microbiome drug metabolism by gut bacteria and their genes","volume":"570","author":"Zimmermann","year":"2019","journal-title":"Nature"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"eaat9931","DOI":"10.1126\/science.aat9931","article-title":"Separating host and microbiome contributions to drug pharmacokinetics and toxicity","volume":"363","author":"Zimmermann","year":"2019","journal-title":"Science"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e10116","DOI":"10.15252\/msb.202010116","article-title":"Towards a mechanistic understanding of reciprocal drug-microbiome interactions","volume":"17","author":"Zimmermann","year":"2021","journal-title":"Mol. Syst. Biol."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Zimmermann, F., Roessler, J., Schmidt, D., Jasina, A., Schumann, P., Gast, M., Poller, W., Leistner, D., Giral, H., and Kr\u00e4nkel, N. (2020). Impact of the Gut Microbiota on Atorvastatin Mediated Effects on Blood Lipids. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051596"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.medj.2022.04.007","article-title":"Heterogeneity in statin responses explained by variation in the human gut microbiome","volume":"3","author":"Wilmanski","year":"2022","journal-title":"Med"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"e00601","DOI":"10.1002\/prp2.601","article-title":"Gut bacterial microbiome composition and statin intake-A systematic review","volume":"8","author":"Dias","year":"2020","journal-title":"Pharmacol. Res. Perspect."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Wang, E.M., Shremo Msdi, A., Quach, V.N., Nguyen, S.Q., Quach, E., Jo, J., Eubank, T.A., Garey, K.W., and Rosario, N. (2025). Angiotensin converting enzyme inhibitors and angiotensin receptor blockers impact on the gut microbiome: A systematic review. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1685424"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"e222","DOI":"10.1002\/imt2.222","article-title":"Intestinal Microbiota by Angiotensin Receptor Blocker Therapy Exerts Protective Effects Against Hypertensive Damages","volume":"3","author":"Li","year":"2024","journal-title":"iMeta"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1210\/clinem\/dgac210","article-title":"Cardiovascular Benefits of Empagliflozin Are Associated With Gut Microbiota and Plasma Metabolites in Type 2 Diabetes","volume":"107","author":"Deng","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.chom.2023.12.015","article-title":"A gut microbiota-bile acid axis promotes intestinal homeostasis upon aspirin-mediated damage","volume":"32","author":"Li","year":"2024","journal-title":"Cell Host Microbe"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"175800","DOI":"10.1016\/j.ejphar.2023.175800","article-title":"Effects of long-term regular oral aspirin combined with atorvastatin to prevent ischemic stroke on human gut microbiota","volume":"951","author":"Chen","year":"2023","journal-title":"Eur. J. Pharmacol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1161\/CIRCRESAHA.118.313142","article-title":"Microbial Transplantation With Human Gut Commensals Containing CutC Is Sufficient to Transmit Enhanced Platelet Reactivity and Thrombosis Potential","volume":"123","author":"Skye","year":"2018","journal-title":"Circ. Res."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.ejps.2018.03.011","article-title":"Pharmacometabolomics analysis of plasma to phenotype clopidogrel high on treatment platelets reactivity in coronary artery disease patients","volume":"117","author":"Amin","year":"2018","journal-title":"Eur. J. Pharm. Sci."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1038\/s41591-025-03615-9","article-title":"Clinical translation of microbiome research","volume":"31","author":"Gilbert","year":"2025","journal-title":"Nat. Med."},{"key":"ref_115","doi-asserted-by":"crossref","unstructured":"Schierwagen, R., Carraturo, F., Iyappan, A., Brol, M.J., Druart, C., Israelsen, M., Hassani, Z., Legent, K., Godoy, Y., and Vecchi, C. (2026). Multidisciplinary Delphi consensus statement on minimal standards for clinical metadata and end points in microbiome studies. Nat. Rev. Gastroenterol. Hepatol.","DOI":"10.1038\/s41575-026-01229-1"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"2323237","DOI":"10.1080\/19490976.2024.2323237","article-title":"Advancing lifelong precision medicine for cardiovascular diseases through gut microbiota modulation","volume":"16","author":"Shi","year":"2024","journal-title":"Gut Microbes"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"128384","DOI":"10.1016\/j.micres.2025.128384","article-title":"Microbiome based precision medicine through integrated multiomics and machine learning","volume":"303","author":"Kumar","year":"2026","journal-title":"Microbiol. Res."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1016\/j.jacc.2023.02.045","article-title":"Gut Microbiome-Based Management of Patients With Heart Failure: JACC Review Topic of the Week","volume":"81","author":"Mamic","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1053\/j.gastro.2025.02.035","article-title":"Machine Learning and Artificial Intelligence in the Multi-Omics Approach to Gut Microbiota","volume":"169","author":"Rozera","year":"2025","journal-title":"Gastroenterology"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"3893","DOI":"10.1007\/s12602-025-10815-9","article-title":"From One-Size-Fits-All to Precision Medicine: The Promise of Personalized Probiotics","volume":"18","year":"2026","journal-title":"Probiotics Antimicrob. Proteins"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"2623359","DOI":"10.1080\/19490976.2026.2623359","article-title":"Precise probiotic therapy: Advances, bottlenecks, and the road to microbiome-informed nutrition","volume":"18","author":"Jiang","year":"2026","journal-title":"Gut Microbes"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jacc.2024.05.003","article-title":"Transforming Cardiovascular Care With Artificial Intelligence: From Discovery to Practice: JACC State-of-the-Art Review","volume":"84","author":"Khera","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1038\/s41575-025-01041-3","article-title":"A Consensus Statement on establishing causality, therapeutic applications and the use of preclinical models in microbiome research","volume":"22","author":"Metwaly","year":"2025","journal-title":"Nat. Rev. Gastroenterol. Hepatol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3091\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:18:59Z","timestamp":1790137139000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":123,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18183091"],"URL":"https:\/\/doi.org\/10.3390\/nu18183091","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}