From gut to heart: Probiotics-driven cholesterol metabolism, mechanisms and health benefits

Abstract

Hypercholesterolemia is a major metabolic disorder that significantly increases the risk of coronary artery disease and other cardiovascular complications. Although conventional lipid-lowering agents, including statins and bile acid sequestrants, are widely used, their long-term administration may be associated with adverse effects and potential disturbances in gut microbiota composition. Consequently, alternative therapeutic strategies, including microbiota-targeted interventions, are being actively explored. Probiotics have emerged as promising candidates for modulating cholesterol metabolism by restoring gut microbial balance and influencing key metabolic pathways. Numerous in vitro, in vivo, and clinical studies demonstrate that probiotic strains, particularly Lactobacillus spp. and Bifidobacterium spp., improve lipid profiles through mechanisms such as bile salt deconjugation, cholesterol assimilation, conversion to Coprostanol, and the production of short-chain fatty acids. This review comprehensively summarizes the molecular mechanisms underlying probiotic-mediated cholesterol regulation and evaluates their translational potential in reducing cardiovascular risk. Furthermore, it highlights current limitations, strain-specific variability, and future research directions for developing targeted probiotic-based therapies.