# The Administration of Probiotics against Hypercholesterolemia: A Systematic Review
## 3 Results  
From 24 clinical trials, 17 full-text articles were considered after implementing the exclusion criteria and represented in Figure 1.  
The details of the reported studies on the influence of probiotics on hypercholesterolemia-terolemia have been summarized in Table 1. The studies revealed the pilot/randomized controlled trial method to investigate the effects of probiotics in hypercholesterolemia-terolemi patients. _Lactobacillus_ (in nine studies), _Bifidobacterium_ (in eight studies), and _Enterococcus_ (in two studies) were the most widely studied genera in these reports. _Saccharomyces_ and _Propionibacterium_ were used in one study. The studies were planned to assess the effects of probiotics on the lipid profile, considered a crucial causative agent of CVD. Figure 1: The PRISMA flow chart represents the selection criteria to review the effects of probiotics in hypercholesterolemia-terolemic subjects. The 33 patients with low and without CVD risk were tested with _Bifidobacterium longum_ BB536 and red yeast rice, which reduced the LDL-c level. The circulating levels of lathosterol in plasma, a marker of cholesterol synthesis, were also significantly reduced (\(p=0.0206\)). It revealed that _B. longum_ BB536 and red yeast rice affect the lathosterol biosynthesis [40]. _L. plantarum_ ECGC 13110402 was administitated with the proper regular diet to 23 people with normal to mildly hypercholesterolemiaemia, which showed a significant difference in the LDL-c concentrations. _L. plantarum_ ECGC 13110402 has high bile salt hydrolase activity, which reduced the LDL-c level and may lower the CVD risk [41]. The isoflav-supplemented soy product fermented with _Enterococcus ficeum_ CRL 183 and _L. helveticus_ 416 was administered to 17 patients. At the end of 42 days, the outcomes were observed that the probiotic intervention significantly reduced the LDL-c level (up to 14.8%) [42]. After eight weeks of daily supplementation to adults with hypercholesterolemiaemia (\(n=11\)) found that _Saccharomyces boulardii_ var. _boulardii_ CNCM 1-1079 significantly reduced (about 15.5%) remnant lipoprotein particles. However, there are no significant changes in total cholesterol (TC), LDL-c, HDL-c, triglycerides (TG), TC/HDL-c, and non-HDL-c [43]. _L. reuteri_ NCIMB 30242 with bile salt hydrolase functionality decreased the LDL-c and increased the circulating bile acid. _L. reuteri_ NCIMB 30242 also increases the serum 25-hydroxyvitamin D (25.5%), which significantly reduces the risk of osteoporosis, CVD, diabetes, and some cancers [44,45]. It may reduce CVD risk and other chronic diseases [46]. However, further experiments are needed to warrant the statement. The probiotic mixture comprised of _B. lactis_ MB 2409, _B. bifidum_ MB 109B, and _B. longum_ BL04 showed a significant decrease in TC, LDL-c, and TG and an increase in HDL-c levels in dyslipidemia children [47]. [PERSON] et al. reported that the supplementation of the probiotic mixture contains three strains of _L. plantarum_ which significantly reduced the TC (13.6%), LDL-c, and oxidized LDL-c levels in hypercholesterolemiaemia adults. It significantly reduces the CVD risk in hypercholesterolemiaemia adults [48]. [PERSON] et al. described that the supplementation of a symbiotic mixture contains _L. acidophilus, B. bifidum_, and oligofructose effectively increased HDL-c and reduced the fasting glycemia in elderly people with type 2 diabetes mellitus [49]. The oral administration of _E. facecium_ M-74 for one year reduces the LDL-c concentration significantly [50]. Iran Dairy Industries uses _Streptococcus thermophilus_ and _Lactobacillus delbrueckii_ subsp. _Bulgaricus_ for making their regular yogurt. Along with those two bacteria, _L. acidophilus_ and _B. lactis_ were used as a starter to prepare probiotic yogurt. The probiotic yogurt had a cholesterol-lowering effect in healthy hypercholesterolemia subjects. Likewise, the yogurt fermented with _L. acidophilus_ and _B.