Table 3.

Known and proposed mechanisms by which the gut microbiota may influence cardiovascular drug outcomes, adapted from Tuteja et al. [121].

Drug	Bacteria	Mechanism(s)	Outcome
Known drug-microbiota interaction
Digoxin [126]	Eggerthella lenta	Inactivation by reduction	Bacterial reductase activity reduces the quantity of active drug reaching target tissues
Proposed drug-microbiota interaction
Simvastatin [127]	Not known	Microbial derived bile acids competing for host uptake transporters Disruption in bacterial communities with bile salt hydrolase (bsh) activity	Reduced amount of drug reaching target tissues FXR receptor signaling variability
Rosuvastatin [128]	Not known	Disruption in host gene expression of bile acid metabolism pathways Disruption in bacterial communities with bile salt hydrolase (bsh) activity	FXR receptor signaling variability
Atorvastatin [129]	Not known	Reduced quantity of secondary bile acids	FXR receptor signaling variability
Amlodipine [130]	Not known	Pre-systemic metabolism by dehydrogenation	Reduced quantity of active drug reaching target tissues
Captopril [121]	Not known	Not known	Improved villi length and reduced intestinal permeability
Aspirin [131]		Not known	Bacterial communities alteration
Warfarin [132]		Antibiotics eliminate vitamin K producing bacteria	Increased bleeding events