Could Your Gut Help Predict Heart Failure Risk?
New research shows gut microbiome biomarkers provide meaningful risk insights beyond standard heart failure models.
Heart failure remains one of the most challenging cardiovascular syndromes to manage, not least because it rarely occurs in isolation.
As global populations age, clinicians are caring for increasing numbers of patients whose heart failure is shaped by a web of interacting comorbidities that extend well beyond the heart itself. This complexity has exposed the limitations of existing risk models, which often struggle to explain why outcomes vary, even among patients receiving optimal therapy.
Toru Suzuki, professor of cardiovascular medicine at the University of Leicester, has long focused on understanding heart failure as a systemic condition. His team’s recent work, published in the European Journal of Preventive Cardiology and funded by the British Heart Foundation, introduces the gut microbiome as a measurable contributor to adverse outcomes in heart failure.
In this interview, Suzuki explains why more refined risk stratification is still needed, how gut-derived biomarkers add new predictive value, and what these findings could mean for future clinical decision-making.
Multimorbidity complicates heart failure risk prediction
Why is improved risk stratification still needed in heart failure?
Heart failure is most frequently diagnosed in older adults, a population in whom multiple chronic conditions are common. In practice, this means that outcomes attributed to heart failure are often influenced by a constellation of systemic disorders, ranging from metabolic disease and organ dysfunction to frailty and nutritional deficiencies.
Suzuki stresses that heart failure cannot be accurately assessed without accounting for this broader physiological landscape. In elderly patients, the primary cardiac condition is often accompanied by diabetes, thyroid disease, obesity, sarcopenia, kidney dysfunction, lung disease, or sleep-disordered breathing, among other factors. Each of these comorbidities may independently contribute to mortality or hospitalization risk.
The challenge, he explains, lies in disentangling these overlapping influences in a way that meaningfully informs management. His group’s work addresses this gap by quantifying, for the first time, the specific contribution of the gut microbiome within the broader context of multimorbidity.
“Delineating the relative contribution of co-morbid conditions to risk of death or rehospitalization is needed for appropriate management of heart failure.” — Prof. Toru Suzuki.
Why multimorbidity must be central to heart failure risk models:
- Heart failure commonly coexists with multiple age-related systemic conditions
- Traditional models struggle to separate cardiac risk from non-cardiac drivers
- Quantifying individual contributors is essential for appropriate management
Expanding risk models with gut-derived biomarkers
How does the inclusion of gut-derived biomarkers improve on existing heart failure risk models?
Most established heart failure risk tools are built around clinical characteristics and conventional laboratory parameters. While valuable, these models largely ignore biological pathways outside the cardiovascular system that can influence outcomes over time.
Suzuki explains that his team’s investigation adds a missing dimension by incorporating gut-derived biomarkers, reflecting metabolic activity driven by the intestinal microbiome. By adding this new layer, the model captures a portion of risk that had previously gone unmeasured, helping to explain adverse outcomes that remain unexplained by standard assessments alone.
“Available heart failure risk models have mainly addressed the contribution of clinical features and conventional blood tests, but our investigation now adds the contribution of the gut-derived biomarkers, which has not been known until now.” — Prof. Toru Suzuki.
How gut biomarkers add predictive power in heart failure risk assessment:
- Conventional models overlook gut-mediated biological pathways
- Gut-derived biomarkers independently contribute to adverse outcome risk
- The microbiome accounts for just under 10% of total risk in the model
Residual risk and its significance for clinical decision-making
How could the new algorithm influence clinical decision-making in heart failure?
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Suzuki explains that the current algorithm is “the first step to understanding the contribution of the gut to heart failure outcomes,” with the hope that it will be applied to clinical decision making and risk stratification.
Previous work from his group has shown that standard heart failure medications do not alter the gut microbiome, suggesting that conventional treatment leaves a residual risk. This could potentially explain why some patients continue to experience deterioration despite receiving seemingly optimal care.
The longer-term goal, Suzuki says, is to identify interventions to reduce the risk from the gut microbiome.
“Previous investigations by ourselves have shown that conventional therapy for heart failure do not affect the gut microbiome, which suggests that there is residual risk even after optimal medical treatment.” — Prof. Toru Suzuki.
The importance of using microbiome risk signals in future heart failure care:
- Residual risk remains despite optimal medical therapy
- Gut-related pathways represent an unmet therapeutic target
- Risk stratification may guide future intervention development
Barriers to clinical adoption of microbiome-based algorithms
What are the main barriers to implementing this type of algorithm in routine care?
At present, the most significant obstacle to routine clinical use is logistical rather than conceptual. The gut-derived biomarkers included in the algorithm are not part of standard blood testing panels currently available in most healthcare systems.
Suzuki emphasizes that this limitation reflects the early stage of translation rather than a fundamental flaw in the approach. As analytical methods evolve and testing becomes more accessible, he anticipates that these biomarkers could be incorporated alongside existing laboratory measures.
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Once available, such testing would allow clinicians to perform a more comprehensive and additive assessment of heart failure risk, without disrupting established diagnostic workflows.
What must change for routine use of microbiome risk tools:
- Current biomarker assays are not yet part of standard testing
- Future availability could enable additive risk assessment
- Integration would complement existing clinical workflows
Diet, the microbiome, and the next phase of research
Are there any current plans to further study the extent to which diet can impact microbiome-related heart failure risk?
Having established the gut microbiome as a quantifiable contributor to heart failure outcomes, Suzuki’s group is now turning toward the question of modifiability. Diet represents one of the most direct influences on microbial composition and metabolic output, making it a logical next focus.
Future research directions targeting the gut–heart axis:
- Diet is a key modulator of gut microbiome activity
- Research is shifting from risk identification to risk reduction
- Lifestyle-based strategies may complement pharmacological therapy
Heart failure risk stratification is entering a new phase, as clinicians and researchers increasingly recognize the importance of systemic and non-cardiac contributors to outcome risk. Suzuki’s work positions the gut microbiome as a quantifiable and independent factor shaping mortality and rehospitalization in heart failure. While practical barriers currently limit routine implementation, the findings clarify an important source of residual risk that persists despite optimal therapy. Ongoing research into dietary modulation of the microbiome may open new avenues for intervention in the years ahead.
Key takeaways:
- Heart failure must be assessed in the context of multimorbidity
- Gut-derived biomarkers capture previously unmeasured risk
- The gut microbiome contributes almost 10% of adverse outcome risk
- Conventional therapies do not modify microbiome-related pathways
- Diet is a major focus of ongoing gut–heart research
This content includes text that has been created with the assistance of generative AI and has undergone editorial review before publishing. Technology Networks' AI policy can be found here.
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