GENERAL SUMMARY
Probiotics (especially L. reuteri, L. plantarum, B. longum, B. breve) help reduce total cholesterol, LDL-C, and triglycerides; increase HDL-C; regulate blood pressure through increased endothelial NO, reduced angiotensin II, decreased inflammatory response, and TMAO—risk factors for atherosclerosis.
Supplementing probiotics in functional foods is a potential supportive treatment for cardiovascular disease prevention, in accordance with FAO/WHO standards (2001).
1. General mechanisms of probiotics on cardiovascular health
Probiotics, especially Lactobacillus reuteri, L. rhamnosus, Bifidobacterium longum, support the prevention of cardiovascular diseases and hypertension by improving vascular function, helping to enhance blood pressure, endothelial function, reduce total cholesterol (TC), "bad" cholesterol (LDL - Low-Density Lipoprotein), triglycerides (TG), while increasing "good" cholesterol (HDL - High-Density Lipoprotein). This is because probiotics play a role in cholesterol assimilation, inhibiting cholesterol absorption, and producing short-chain fatty acids (SCFA) that help reduce LDL and TG. The molecular mechanism is related to probiotics activating the insulin - SP1(P) - CYP27A - LXRα/β - ABCA1 pathway in the intestine, leading to increased synthesis of HDL3 in the intestine, a form of HDL with strong cardioprotective effects, while also reducing cholesterol absorption in the intestine.[1]
2. Probiotics in the prevention of coronary artery disease
The gut microbiota plays an essential role in preventing coronary artery disease (CAD) by protecting intestinal health from dysbiosis, which is closely linked to the development of CAD. Probiotics demonstrate effective mechanisms in controlling risk factors and reducing CAD, such as anti-inflammatory and antioxidant roles. Other mechanisms include reducing or preventing CAD risk factors achieved through the hypoglycemic and antihypertensive effects of probiotics, as well as reducing metabolic disorders. These effects also help prevent obesity and hypercholesterolemia, thus confirming the effective role of probiotics in preventing CAD.
A meta-analysis of 16 trials from 2019 to 2025 showed that supplementation with L. plantarum or B. breve for 12 weeks helped reduce LDL-C by 10-12 mg/dL, triglycerides by 15%, and diastolic blood pressure by 2-4 mmHg.[2]
3. Probiotics and reducing cardiovascular risk in the community
There is a beneficial relationship between the consumption of probiotics and cardiovascular health in patients with existing atherosclerotic disease.
A cross-sectional study using large databases from the US National Health and Nutrition Examination Survey (NHANES) between 1999-2020 included adults diagnosed with at least one of the following: coronary artery disease, angina, or myocardial infarction, or at least two of diabetes, hypertension, and hypercholesterolemia. The results showed that probiotic use was associated with lower HbA1c levels (p < 0.001), lower triglycerides (p < 0.001), lower atherosclerotic cardiovascular disease (ASCVD) risk score (p = 0.01), and higher HDL-C (p < 0.001). The use of probiotic supplements was also associated with lower LDL-C (p = 0.003) and lower total cholesterol (p = 0.047).[3]
4. Lactobacillus reuteri in cholesterol control
L. reuteri significantly reduces total cholesterol, thereby contributing to lowering cardiovascular risk associated with hypercholesterolemia.
A survey investigating the effects of L. reuteri consumption on major cardiovascular risk factors including blood pressure, blood lipids, and blood glucose included 6 studies with 4 different L. reuteri strains and 512 participants analyzed. The results showed that consumption of L. reuteri significantly reduced total cholesterol (TC) by an average of -0.26 mmol/L and LDL-C by 9-11%. This effect is due to probiotics reducing intestinal cholesterol absorption and increasing bile-salt hydrolase enzyme levels.[4]
5. Bifidobacterium and the gut-liver-heart axis
Gut microbiota and their metabolites are linked to the progression of cardiovascular disease, and the gut-liver circulation plays an important role in this process. A study showed that Bifidobacterium could provide cardioprotective effects via the gut-liver-heart axis. This study was conducted on 10 patients with unstable angina (UA), administering Bifidobacterium (630 mg/dose, twice daily). After 1 month, levels of TMAO (trimethylamine N-oxide), aspartate aminotransferase, total cholesterol, and low-density lipoproteins decreased significantly compared to before (P < 0.05).[5]
6. The role of probiotics in blood pressure regulation
Probiotics may participate in blood pressure regulation through multiple mechanisms such as improving endothelial function, reducing oxidative stress, modulating gut microbiota composition, producing anti-inflammatory metabolites like short-chain fatty acids, regulating bile acid metabolism, etc.
A randomized, double-blind, placebo-controlled study with a 12-week intervention using high-dose multiform probiotics (10¹⁰ CFU/L/day, including Bifidobacteria longum and Lactobacilli) significantly reduced blood pressure in hypertensive subjects. The probiotic group showed an average reduction in systolic blood pressure (SBP) of 8.6 mm Hg and diastolic blood pressure (DBP) was also reduced accordingly. Notably, 67% of people using probiotics achieved a reduction in systolic blood pressure ≥ 10 mm Hg, compared to only 18% in the placebo group.[6]
MAIN REFERENCES
1. López‑Yerena A. et al. (2024). Probiotics: A Potential Strategy for Preventing and Reducing Cardiovascular Risk Factors. Nutrients. https://pubmed.ncbi.nlm.nih.gov/39796486/
2. Hashish R. et al. (2025). The Promising Role of Probiotics in the Prevention of Cardiovascular Risk Factors and Their Implication in Reducing Coronary Artery Disease: A Literature Review. Frontiers in Nutrition. https://pmc.ncbi.nlm.nih.gov/articles/PMC12176072/
3. Palathinkara M. et al. (2025). Association of probiotic supplementation and cardiovascular risk profiles of patients with coronary artery disease-a cross-sectional analysis of the NHANES database between 1999-2019; https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1495633/full
Front Nutr. https://pubmed.ncbi.nlm.nih.gov/40093880/
4. Liu J. et al. (2023). Limosilactobacillus reuteri Consumption Significantly Reduces Cholesterol. Clin Nutr.
https://pubmed.ncbi.nlm.nih.gov/37419064/
5. Zhou Z. et al. (2025). Probiotic Bifidobacterium Reduces Serum TMAO in Unstable Angina Patients. Front Microbiol. https://pmc.ncbi.nlm.nih.gov/articles/PMC11977283/
6. The Impact of Probiotics on Blood Pressure. Rev Hipertensión (2025). https://www.revhipertension.com/rlh_3_2025/6_the_impact_probiotics_blood_pressure.pdf
OTHER REFERENCES
7. FAO/WHO (2001). Health and Nutritional Properties of Probiotics in Food.https://www.fao.org/3/a0512e/a0512e.pdf
8. Kechagia M. et al (2013), “Health Benefits of Probiotics: A Review”, ISRN Nutr. 2013 Jan 2;2013:481651. doi: 10.5402/2013/481651.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4045285/
9. Dong J. et al. (2025). Beneficial Effects of Probiotics on Patients with Coronary Heart Disease. Front Nutr. https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1612021/full
10. Tang J. et al. (2023). Therapeutic Value of Bifidobacteria in Cardiovascular Diseases. Nature Communications. https://www.nature.com/articles/s41522-023-00448-7
11. Ghanbari F. et al. (2024). Preventive Effect of Probiotics, Prebiotics, and Synbiotics on Lipid Abnormalities. Food Sci Nutr.