Research Progress on the Association Between the Oral–Gut Microbiota Axis and Cardiovascular Disease

Cardiovascular disease (CVD) remains the leading cause of global mortality despite substantial advances in the pathophysiological understanding and clinical management of this disease. Emerging evidence implicates the oral and intestinal microbiota—two highly complex microbial ecosystems—as critical modulators of cardiovascular homeostasis. These communities are shaped by host immunity, lifestyle, aging, diet, pharmacological agents, and environmental exposure; their dysbiosis has been causally linked to a spectrum of chronic disorders, including CVD. This suggests that the oral and gut microbiota constitute tractable biological targets for CVD intervention. Here, we first delineate the compositional and functional interrelationship between the oral and gut microbiomes. We then summarize mechanistic pathways through which the oral–gut microbiota axis may drive CVD, including (i) direct endothelial invasion, (ii) microbial translocation, (iii) platelet hyperaggregation, (iv) immune-mediated systemic inflammation, and (v) microbial metabolite–host interactions. Finally, we review clinical associations between the oral–gut axis and prevalent CVD phenotypes—atherosclerosis, hypertension, myocardial infarction, and heart failure—and discuss translational perspectives for microbiota-directed therapeutics.