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<p>Coronary artery disease (CAD) remains a leading cause of mortality worldwide, driven by persistent inflammation, metabolic dysfunction, and endothelial impairment despite optimal medical therapy. Modulating the gut microbiota through probiotics, prebiotics, or synbiotics has emerged as a potential adjunctive strategy. This study aimed to assess the effects of microbiota-targeted interventions on clinical, inflammatory, and metabolic outcomes in patients with CAD. We systematically searched PubMed, Scopus, Cochrane Library, and Epistemonikos from inception to March 27, 2026. Thirteen randomized controlled trials (RCTs) involving 793 participants were included. Data were pooled using a random-effects model to calculate mean differences (MD) and 95% confidence intervals (CI). Overall, significant improvements were observed for HDL‑C (MD 0.08 mmol/L), TC (MD − 0.42 mmol/L), TG (MD − 0.15 mmol/L), FPG (MD − 0.66 mmol/L), insulin (MD − 3.12 µIU/mL), HOMA‑IR (MD − 0.83), IL‑6 (MD − 14.78 pg/mL), LPS (MD − 4.25 EU/L), MDA (MD − 0.31 µmol/L), TAC (MD 56.07 mmol/L), NO (MD 6.76 µmol/L), hs-CRP (MD − 7.54&#xa0;mg/L), and LVEF (MD 4.24 in probiotic subgroup). Synbiotics demonstrated promising point estimates for several inflammatory and endotoxemia-related outcomes. However, these findings were based on a limited number of studies, and statistically significant benefits were not consistently observed across other outcomes, including HDL-C, FPG, and HOMA-IR. Therefore, these findings should be considered preliminary and should not be interpreted as evidence of superiority over probiotics or prebiotics. Microbiota-targeted interventions may provide beneficial adjunctive effects on cardiometabolic, inflammatory, oxidative stress, and endothelial outcomes in patients with CAD. Although synbiotics demonstrated promising findings for several inflammatory and endotoxemia-related biomarkers, direct head-to-head comparisons between probiotics, prebiotics, and synbiotics are lacking. Therefore, no definitive conclusions regarding the superiority of any intervention type can be drawn, and larger well-designed randomized controlled trials are warranted to confirm these findings.</p>

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Comparative Effects of Probiotics, Prebiotics, and Synbiotics on Clinical Outcomes in Coronary Artery Disease: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年8月5日

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  • Muhammad Reva Aditya,
  • Frengki Prabowo Saputro Wijayanto,
  • Artha Maressa Theodora Simanjuntak,
  • Michael Owen Hogipranata,
  • Rizki Hari Mulia,
  • Budi Satrijo,
  • Hikmawan Wahyu Sulistomo

摘要

Coronary artery disease (CAD) remains a leading cause of mortality worldwide, driven by persistent inflammation, metabolic dysfunction, and endothelial impairment despite optimal medical therapy. Modulating the gut microbiota through probiotics, prebiotics, or synbiotics has emerged as a potential adjunctive strategy. This study aimed to assess the effects of microbiota-targeted interventions on clinical, inflammatory, and metabolic outcomes in patients with CAD. We systematically searched PubMed, Scopus, Cochrane Library, and Epistemonikos from inception to March 27, 2026. Thirteen randomized controlled trials (RCTs) involving 793 participants were included. Data were pooled using a random-effects model to calculate mean differences (MD) and 95% confidence intervals (CI). Overall, significant improvements were observed for HDL‑C (MD 0.08 mmol/L), TC (MD − 0.42 mmol/L), TG (MD − 0.15 mmol/L), FPG (MD − 0.66 mmol/L), insulin (MD − 3.12 µIU/mL), HOMA‑IR (MD − 0.83), IL‑6 (MD − 14.78 pg/mL), LPS (MD − 4.25 EU/L), MDA (MD − 0.31 µmol/L), TAC (MD 56.07 mmol/L), NO (MD 6.76 µmol/L), hs-CRP (MD − 7.54 mg/L), and LVEF (MD 4.24 in probiotic subgroup). Synbiotics demonstrated promising point estimates for several inflammatory and endotoxemia-related outcomes. However, these findings were based on a limited number of studies, and statistically significant benefits were not consistently observed across other outcomes, including HDL-C, FPG, and HOMA-IR. Therefore, these findings should be considered preliminary and should not be interpreted as evidence of superiority over probiotics or prebiotics. Microbiota-targeted interventions may provide beneficial adjunctive effects on cardiometabolic, inflammatory, oxidative stress, and endothelial outcomes in patients with CAD. Although synbiotics demonstrated promising findings for several inflammatory and endotoxemia-related biomarkers, direct head-to-head comparisons between probiotics, prebiotics, and synbiotics are lacking. Therefore, no definitive conclusions regarding the superiority of any intervention type can be drawn, and larger well-designed randomized controlled trials are warranted to confirm these findings.