Akkermansia muciniphila in cardiovascular diseases: opportunities and challenges.

Cardiovascular disease (CVD) is one of the leading causes of death worldwide and poses a severe threat to human health. Recent years have witnessed a growing interest in how the gut microbiota regulates the cardiovascular system. Akkermansia muciniphila (A. muciniphila), a key constituent of this community, has become a focus of research on CVD prevention owing to its critical role in maintaining gut homeostasis, modulating metabolism, and regulating immunity. This review details the beneficial effects and mechanisms of action of A. muciniphila in CVD. A. muciniphila protects against conditions such as hypertension, atherosclerosis, heart failure, and abdominal aortic aneurysm by repairing the gut barrier, balancing glucose and lipid metabolism, regulating immune-inflammatory responses, and producing protective metabolites such as short-chain fatty acids. However, in pathological states, such as a damaged gut barrier or low-fiber diets, A. muciniphila can over-proliferate, accelerate mucus breakdown, and exacerbate inflammation and disease progression-revealing a "double-edged sword" character. Furthermore, diet, medications, and an individual's baseline gut microbiota directly modulate their abundance, underscoring the need for personalized approaches. Future studies should focus on clarifying strain differences, establishing safe dosing, and optimizing delivery systems to advance the clinical application of A. muciniphila in CVD therapy.