What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Heart failure or post-myocardial infarction (n=366). Intervention: Probiotics vs. Placebo. Primary outcome: Left Ventricular Ejection Fraction (LVEF) (MD -0.20, 95% CI -2.48 to 2.09, p=0.87).

What does this research mean for the field?

Probiotics do not significantly improve left ventricular ejection fraction or high-sensitivity C-reactive protein compared to placebo in heart failure or post-myocardial infarction patients, despite potential metabolic and anti-inflammatory benefits. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 22, 2023Open Access

Anti-Inflammatory, Antioxidant, Metabolic and Gut Microbiota Modulation Activities of Probiotic in Cardiac Remodeling Condition: Evidence from Systematic Study and Meta-Analysis of Randomized Controlled Trials

Key Result

Probiotics did not significantly improve left ventricular ejection fraction (MD -0.20, p=0.87) or high-sensitivity C-reactive protein (MD -0.34, p=0.06) compared to placebo in HF or post-MI patients.

Study Design

Type

Meta-Analysis (n=366)

Structured PICO

Do probiotics improve LVEF and hs-CRP in post-myocardial infarction or heart failure patients?

Population

366 post-myocardial infarction or heart failure patients from 6 RCTs

Intervention

Probiotics (various strains and doses)

Comparator

Placebo

Outcome

Left ventricular ejection fraction (LVEF) and high-sensitivity C-reactive protein (hs-CRP)surrogate

Probiotics did not significantly improve LVEF or hs-CRP in patients with heart failure or post-myocardial infarction, though they showed potential in modulating certain biomarkers and sarcopenia indices.

Main Result

Effect estimate: MD -0.20 (95% CI -2.48 to 2.09)

p-value: p=0.87

Limitations

Studies regarding the effects of probiotics on cardiac remodeling are still very heterogeneous in terms of outcomes and study population.
The available studies use different kinds and doses of probiotics between studies.
The number of samples included in this analysis was relatively small given the short duration of follow-up or intervention to observe cardiac remodeling.

Abstract

Heart failure (HF) is a global pandemic with increasing prevalence and mortality rates annually. Its main cause is myocardial infarction (MI), followed by rapid cardiac remodeling. Several clinical studies have shown that probiotics can improve the quality of life and reduce cardiovascular risk factors. This systematic review and meta-analysis aimed to investigate the effectiveness of probiotics in preventing HF caused by a MI according to a prospectively registered protocol (PROSPERO: CRD42023388870). Four independent evaluators independently extracted the data using predefined extraction forms and evaluated the eligibility and accuracy of the studies. A total of six studies consisting of 366 participants were included in the systematic review. Probiotics are not significant in intervening left ventricular ejection fraction (LVEF) and high-sensitivity C-reactive protein (hs-CRP) when compared between the intervention group and the control group due to inadequate studies supporting its efficacy. Among sarcopenia indexes, hand grip strength (HGS) showed robust correlations with the Wnt biomarkers (p < 0.05), improved short physical performance battery (SPPB) scores were also strongly correlated with Dickkopf-related protein (Dkk)-3, followed by Dkk-1, and sterol regulatory element-binding protein 1 (SREBP-1) (p < 0.05). The probiotic group showed improvement in total cholesterol (p = 0.01) and uric acid (p = 0.014) compared to the baseline. Finally, probiotic supplements may be an anti-inflammatory, antioxidant, metabolic, and intestinal microbiota modulator in cardiac remodeling conditions. Probiotics have great potential to attenuate cardiac remodeling in HF or post-MI patients while also enhancing the Wnt signaling pathway which can improve sarcopenia under such conditions.

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