Cardiovascular disease (CVD) is the leading cause of death worldwide. The gut microbiota and its associated metabolites may be involved in the development and progression of CVD, although the mechanisms and impact on clinical outcomes are not fully understood. This study investigated the gut microbiome profile and associated metabolites in chronic stable angina (CSA) and acute coronary syndrome (ACS) patients compared to healthy controls. Bacterial alpha diversity in stool from ACS or CSA patients was comparable to healthy controls at both baseline and follow-up visits. Differential abundance analysis identified operational taxonomic units assigned to commensal taxa differentiating ACS patients from healthy controls at both baseline and follow up. Both CSA and ACS patients had significantly higher levels of trimethylamine N-oxide compared to healthy controls (CSA; 0.032 ± 0.023 mmol/L, p <0.01 vs healthy and ACS; 0.032 ± 0.023 mmol/L , p =0.02 vs healthy respectively). ACS patients had reduced levels of propionate, and butyrate (119 ± 4 vs 139 ± 5.1 µM, p =0.001 and 14 ± 4.3 vs 23.5 ± 8.1 µM, p <0.001 respectively), as well as elevated serum sCD14 (2245 ± 75.1 vs 1834 ± 45.8 ng/mL, p <0.0001) and sCD163 levels (457.3 ± 31.8 vs 326.8 ± 20.7 ng/mL, p =0.001), compared to healthy controls at baseline. Furthermore, a modified small molecule metabolomic and lipidomic signature was observed in both CSA and ACS patients compared to healthy controls. These findings provide evidence of a link between gut microbiome composition and gut bacterial metabolites with CVD.