Probiotic Supplementation and Inflammatory Status in Coronary Artery Disease: A Systematic Review and Meta-Analysis

Coronary artery disease (CAD), a major contributor to healthcare burdens worldwide, is closely linked with chronic inflammation. Probiotic supplementation has been investigated for its potential to modulate inflammatory responses, yet its role in patients with CAD remains unclear. To address this, we conducted a systematic review and meta-analysis following PRISMA guidelines, with literature searches performed across PubMed, EMBASE, and Cochrane CENTRAL up to 19 March 2025. Eligible studies included randomized controlled trials that examined the effects of probiotics, prebiotics, or synbiotics in patients with CAD or ischemic heart disease. Study quality was assessed using the Cochrane Collaboration tool, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for pooled outcomes. A total of five randomized controlled trials involving 256 patients with CAD were included. The meta-analysis demonstrated significant improvements in inflammatory biomarkers among participants receiving probiotics compared with those in the placebo group. Specifically, probiotic supplementation led to greater reductions in high-sensitivity C-reactive protein (pooled SMD [pSMD] = -0.61; 95% confidence interval [CI]: -0.87 to -0.36) and malondialdehyde (pSMD = -0.52; 95% CI: -0.91 to -0.12). No significant increase was observed in nitric oxide (pSMD = 0.91; 95% CI: -3.72 to 5.54) or total antioxidant capacity (pSMD = 0.35; 95% CI: -2.16 to 2.86) in the intervention group over control. No significant difference was found in glutathione levels between the two groups (pSMD = 0.01; 95% CI: -0.51 to 0.53). Overall, these findings suggest that probiotic supplementation exerts a beneficial effect on inflammatory status in patients with CAD. The evidence highlights its potential in reducing systemic inflammation and oxidative stress, as reflected by improvements in high-sensitivity C-reactive protein and malondialdehyde.