Gut microbiota as a biomarker for predicting recurrence of cardiovascular events in secondary prevention: the CordioPrev study

• Autores: Javier Arenas Montes
• Directores de la Tesis: José López Miranda (dir. tes.), Antonio Camargo Garcia (dir. tes.)
• Lectura: En la Universidad de Córdoba (ESP) ( España ) en 2026
• Idioma: inglés
• Tribunal Calificador de la Tesis: Francisco Fuentes Jiménez (presid.), Sabela García Benito (secret.), Luis Antonio Álvarez-Sala Walther (voc.)
• Programa de doctorado: Programa Oficial de Doctorado en Biomedicina
• Enlaces
  • Tesis en acceso abierto en: Helvia
• Resumen

  • Preventing new cardiovascular events in patients with established cardiovascular disease (CVD) is a daunting task for clinicians. Current models used to predict CVD in secondary prevention have demonstrated low predictive power and do not indicate the most advisable type of diet.

    Three main mechanisms have been proposed by which the gut microbiota influences the development of CVD: (i) the integrity of the intestinal barrier, (ii) the regulation of cholesterol and lipid metabolism, and (iii) the effects of specific dietary components metabolized by the gut microbiota. Moreover, it has been described that the alterations in the intestinal microbiota observed in men with coronary heart disease (CHD) are different from those found in women with CHD compared to a population of individuals without CVD. In addition, recent studies suggest that the gut microbiota determines the response to dietary interventions, suggesting its potential use as a predictive biomarker of the beneficial effect of consuming one diet or another on CVD.

    Hypothesis: The risk of suffering new major adverse cardiovascular events (MACE) in CHD patients may be associated with a specific intestinal microbiota pattern which might be further used to predict CVD risk in secondary prevention. This microbiota pattern may also help to predict which patients might benefit more from the Mediterranean (MED) diet and may yield information on whether the MED or a low-fat (LF) diet could be more beneficial for a given patient, thus providing personalized medicine. Additionally, the risk of suffering new MACE in CHD may be associated to a specific intestinal microbiota pattern according to the sex.

    Main objective: To develop microbiota-specific mathematical models and cardiovascular risk scores to predict the 7-year risk of recurrence in CHD patients, and to independently quantify the risk associated with adherence to the MED and LF dietary patterns, as well as the risk associated with sex, with the aim of improving risk stratification and supporting personalized recommendations.

    Conclusions: Conclusion 1: A specific gut microbiota pattern is associated with MACE in patients with CHD, which helps in the identification of individuals at high risk of recurrent MACE.

    Conclusion 2: The magnitude of postprandial endotoxemia is associated with new MACE in CHD patients. MED diet consumption induced a higher preventive role than an LF diet when the LPS postprandial increase was moderate.

    Conclusion 3: Gut microbiota improves the prediction of MACE recurrence associated with adherence to the MED and LF diets. These diets are associated with distinct gut microbiota patterns linked to MACE recurrence.

    Conclusion 4: Taking into account both gut microbiota and sex improves the prediction of cardiovascular disease recurrence. Men and women exhibit different gut microbiota patterns associated with MACE recurrence.

    Conclusion 5: Overall, gut microbiota, postprandial endotoxemia, dietary patterns and sex are key determinants of recurrent cardiovascular events and enable us to design precision nutrition strategies in the secondary prevention of CVD.