Turning by-products into health: fermentation-driven production of bioactive compounds for cardiovascular disease prevention

Cardiovascular diseases (CVDs) remain the leading cause of death globally and pose a growing public health burden due to their economic impact on healthcare systems. Metabolic conditions and unhealthy lifestyles contribute to the progression of conditions closely linked to CVDs. Functional foods containing bioactive compounds have been demonstrated as a valid dietary strategy to mitigate risk factors associated with CVDs, offering multi-targeted preventive effects. However, their production can vary in methods, safety, yield, sustainability, and cost, influencing their accessibility and widespread use. Fermentation is an amply validated method for the design of functional foods, offering a sustainable and cost-effective approach to industrial production of bioactive compounds. Moreover, using agri-food by-products can further reduce costs and increase the process sustainability and product bioactivity. This process enables the biosynthesis and enrichment of key cardioprotective metabolites, which have been shown to exert antihypertensive, lipid-lowering, antioxidant, and other health-promoting activities. The review provides an overview of recent studies on bioactive compounds such as monacolin K (MK), peptides, γ-aminobutyric acid (GABA), phenol, and other health-promoting molecules. Here, cardiovascular benefits and the role of fermentation in their production from low-cost substrates are discussed to meet growing global demands for functional foods.