ISBN: 978-93-94174-16_0

Fermented Foods and Cardiovascular Disease: Mechanisms, Epidemiological Evidence, and Therapeutic Potential

Department of Food Processing Technology, AMET (Deemed to be University), Chennai, Tamil Nadu, India

Cardiovascular disease (CVD) remains the leading cause of global morbidity and mortality, highlighting the need for effective dietary strategies to reduce cardiovascular risk. Fermented foods have gained considerable attention as functional foods because fermentation enhances the nutritional value of foods while generating bioactive compounds, including probiotics, postbiotics, bioactive peptides, short-chain fatty acids, organic acids, vitamins, and antioxidant metabolites. These bioactive constituents contribute to cardiovascular health through multiple mechanisms, including modulation of the gut microbiota, improvement of lipid metabolism, regulation of blood pressure, attenuation of oxidative stress and chronic inflammation, enhancement of endothelial function, and maintenance of metabolic homeostasis. Growing evidence from epidemiological studies, prospective cohort studies, randomized clinical trials, and recent meta-analyses suggests that regular consumption of fermented foods is associated with a reduced risk of cardiovascular disease. Fermented dairy products, particularly yogurt, kefir, cheese, and fermented milk, have demonstrated beneficial effects on blood lipid profiles, blood pressure, and inflammatory biomarkers. Similarly, fermented soy products such as natto and miso provide bioactive peptides and isoflavones that may improve vascular function and reduce cardiometabolic risk. Fermentation-derived metabolites have also shown potential in mitigating major cardiovascular risk factors, including dyslipidaemia, hypertension, obesity, insulin resistance, and endothelial dysfunction. This chapter reviews the classification of fermented foods, their major bioactive constituents, underlying cardioprotective mechanisms, and evidence from experimental, epidemiological, and clinical studies. It also discusses current research gaps, emerging fermentation technologies, and future perspectives for developing evidence-based functional foods. Overall, fermented foods represent a promising nutritional strategy for cardiovascular disease prevention and supportive cardiometabolic health.

*Corresponding author; e-mail: nivethakrishnaa20@gmail.com

Cite this Chapter: Nivetha Muralikrishna. 2026. Fermented Foods and Cardiovascular Disease: Mechanisms, Epidemiological Evidence, and Therapeutic Potential. In: M. Kannan and Bhuvaneswari Rajagopal (Eds.), Advances in Aquatic Nutraceutical and Drugs. Excellent Publishers, India. pp. 111-119. doi: https://doi.org/10.20546/978-93-94174-16-0_7