NR1H4 and congestive heart failure: Mayerhofer et al. (2017) reported that low levels of primary and secondary BAs are associated with worse overall survival in patients with chronic heart failure. Meanwhile, lower serum levels of total BAs could indicate the presence and severity of coronary artery disease (Li et al., 2020). In addition, secondary BAs can reduce cholesterol levels by activating FXR and TGR5 (Jia et al., 2023), which contribute to the beneficial effect on the outcome of CVD. Therefore, an unbalanced composition of BAs could potentially increase cholesterol and CVD progression (Kazemian et al., 2020).