2025-07-15
Viruses in our gut, a threat to the heart?
Cardiology and Vascular Medicine Endocrinology and Metabolism Infectiology
#CVD #virome #virus #microbiota
Cardiovascular diseases (CVD) remain the leading cause of death worldwide, representing a major public health concern, particularly among the elderly. Until now, research has primarily focused on traditional risk factors such as genetics, dietary habits, and imbalances in the bacterial gut microbiota. However, a new dimension is gaining attention: the gut virome—the collection of viruses within our digestive tract, mainly bacteriophages and eukaryotic viruses.
Despite their abundance, these viruses are largely overlooked in current diagnostic and therapeutic approaches. Their extreme genetic diversity, lack of comprehensive virome databases, and the complexity of their interactions with the bacterial microbiota, host immunity, and metabolic pathways make their study especially challenging.
These scientific gaps hinder a fully integrated understanding of the virome's potential role in cardiovascular health. This review was conducted to investigate the role of the gut virome in the development and progression of CVD. It aims to broaden the current paradigm by incorporating the viral component into cardiovascular pathogenic models, thereby opening new avenues for prevention, diagnosis, and therapeutic intervention.
The virome: hidden master of cardiovascular health?
The selected studies include metagenomic analyses on human and animal samples, highlighting the increased presence of enteroviruses and phages in various types of CVD.
Significant alterations in the composition of the gut virome were observed in patients with different cardiovascular conditions. In hypertension, a high prevalence of enteroviruses—especially coxsackievirus—and specific phages was noted. In atherosclerosis and coronary heart disease, data showed deep alterations in the virome’s structure, with a marked increase in viral families like Siphoviridae and Virgaviridae.
For atrial fibrillation, distinct virome signatures were identified, suggesting a potential role in risk stratification. Notable virome changes were also found in heart failure and viral myocarditis, particularly a proliferation of Enterococcus phages and the persistent presence of coxsackievirus B3, closely linked to myocardial pathogenesis. These findings support the hypothesis that gut viruses may actively contribute to cardiovascular imbalances through immune, inflammatory, and metabolic mechanisms.
So, what should we do with the virome?
Cardiovascular diseases include major conditions such as hypertension, atherosclerosis, and heart failure, yet the understanding of their potential link with the gut virome remains hindered by viral genetic complexity, current sequencing limitations, and the absence of robust virome databases. Moreover, establishing a clear causal relationship between the virome and CVD remains a major methodological challenge.
The goal of this review was to systematically analyze the involvement of the gut virome in CVD and to propose an integrative approach beyond the traditional bacterial paradigm. This pioneering exploration highlights the virome’s potential as an innovative therapeutic target. Its influence on immune responses, inflammatory pathways, and cardiac metabolism warrants increased attention.
However, several limitations remain: small sample sizes, methodological heterogeneity, and a lack of longitudinal studies reduce the strength of current conclusions. To advance the field, it is essential to develop more powerful sequencing technologies, conduct rigorous longitudinal cohorts, integrate virome analysis into preventive medicine strategies, and explore therapeutic opportunities through prebiotics or viral transplantation.
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About the author – Ana Espino

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