Probiotics in Cardiometabolic Diseases: Current Evidence, Postbiotic Perspectives, and Future Directions

The rise in urbanization and sedentary lifestyles, along with the aging of the global population, is contributing to an increasing burden of life-threatening diseases. The cardiometabolic disease (CMD) spectrum, which includes heart failure, hypertension, coronary heart disease, and diabetes, is closely associated with metabolic syndrome components such as obesity and elevated hepatic lipid accumulation. The gut microbiome mediates these disorders through multiple signaling axes. Imbalance of the intestinal microbiota is closely linked to the pathogenesis of atherosclerosis and hypertensive vascular remodeling. Supplementation with probiotics - and, more recently, their derived postbiotic products - can alter the composition and functional metabolic outputs of the gut ecosystem, offering a mechanistically informed approach for CMD management. This review delineates the mechanisms of action of six well-studied probiotics (Akkermansia muciniphila, Bifidobacterium, Lactobacillus, Bacillus, Enterococcus, and Lactococcus lactis), with selected discussion of their postbiotic derivatives where evidence is available. We further examine how antimicrobial and metabolic interventions integrated through the gut-heart-liver axis may improve clinical outcomes and attenuate disease progression. The advancement of precision cardiometabolic medicine through the combined effects of these therapies may facilitate the development of personalized treatment strategies.