Ethanol: striking the cardiovascular system by harming the gut microbiota

Am J Physiol Heart Circ Physiol. 2021 Aug 1;321(2):H275-H291. doi: 10.1152/ajpheart.00225.2021. Epub 2021 Jun 18.


Ethanol consumption represents a significant public health problem, and excessive ethanol intake is a risk factor for cardiovascular disease (CVD), one of the leading causes of death and disability worldwide. The mechanisms underlying the effects of ethanol on the cardiovascular system are complex and not fully comprehended. The gut microbiota and their metabolites are indispensable symbionts essential for health and homeostasis and therefore, have emerged as potential contributors to ethanol-induced cardiovascular system dysfunction. By mechanisms that are not completely understood, the gut microbiota modulates the immune system and activates several signaling pathways that stimulate inflammatory responses, which in turn, contribute to the development and progression of CVD. This review summarizes preclinical and clinical evidence on the effects of ethanol in the gut microbiota and discusses the mechanisms by which ethanol-induced gut dysbiosis leads to the activation of the immune system and cardiovascular dysfunction. The cross talk between ethanol consumption and the gut microbiota and its implications are detailed. In summary, an imbalance in the symbiotic relationship between the host and the commensal microbiota in a holobiont, as seen with ethanol consumption, may contribute to CVD. Therefore, manipulating the gut microbiota, by using antibiotics, probiotics, prebiotics, and fecal microbiota transplantation might prove a valuable opportunity to prevent/mitigate the deleterious effects of ethanol and improve cardiovascular health and risk prevention.

Keywords: cardiovascular system; dysbiosis; ethanol; gut microbiota; immune system.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Alcohol Drinking / immunology
  • Alcohol Drinking / physiopathology*
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Infective Agents, Local
  • Cardiovascular Diseases / immunology
  • Cardiovascular Diseases / physiopathology*
  • Cardiovascular Diseases / therapy
  • Dysbiosis / immunology
  • Dysbiosis / physiopathology*
  • Dysbiosis / therapy
  • Ethanol
  • Fecal Microbiota Transplantation
  • Gastrointestinal Microbiome*
  • Humans
  • Prebiotics
  • Probiotics / therapeutic use


  • Anti-Bacterial Agents
  • Anti-Infective Agents, Local
  • Prebiotics
  • Ethanol