The role of metabolic profiling and dietary intervention in the early diagnosis and prevention of atherosclerosis.

PURPOSE OF REVIEW: Atherosclerotic cardiovascular disease (ACVD) causes more than 17 million deaths annually, and traditional risk scores capture only part of individual risk. Metabolomic and lipidomic profiling has emerged as a route to better risk stratification and to mechanistic insight into how diet shapes atherogenesis. This narrative review summarizes the most replicated circulating biomarkers of ACVD and the dietary patterns that modulate them.

RECENT FINDINGS: Eight metabolite classes - trimethylamine N-oxide (TMAO), phenylacetylglutamine (PAGln), short-chain fatty acids (SCFAs), lysophosphatidylcholines (LPC), ceramides, branched-chain amino acids (BCAAs), acylcarnitines, and bile acids - show consistent associations with coronary artery disease, plaque burden, and adverse cardiovascular events across recent cohort and case-control studies. Mediterranean-style and DASH dietary patterns are associated with favorable shifts in these biomarkers, including reductions in TMAO, ceramides, and BCAAs, and increases in SCFAs.

SUMMARY: Metabolomic biomarkers add biological depth to cardiovascular risk assessment and provide a measurable readout of dietary exposure. Standardized analytical protocols, validated clinical thresholds, and prospective interventional studies are needed before these markers can be used routinely for risk stratification or disease monitoring.