Global Research Landscape on Lactobacillus-Based Interventions for Hypercholesterolemia: A Bibliometric and Systematic Review of Scientific Evidence and Therapeutic Efficacy

The rising prevalence of hypercholesterolemia has increased interest in Lactobacillus-based probiotic interventions as complementary approaches for lipid management. This study synthesizes clinical evidence and research trends to evaluate the efficacy of Lactobacillus supplementation in improving cholesterol profiles. A systematic review was performed following PRISMA 2020 guidelines and registered in OSF with methodological quality assessed using the Critical Appraisal Skills Programme (CASP) Checklist for RCTs, including randomized controlled trials published between 2015 and 2025. Concurrently, a bibliometric analysis of Scopus and PubMed metadata, conducted using Biblioshiny and VOSviewer, characterized global publication trends, leading authors, and thematic structures. The bibliometric analysis demonstrated rapid scientific growth, notable regional clustering in East and Southeast Asia, and evolving research themes related to gut microbiota and metabolic regulation. Seven randomized controlled trials involving 357 adults with dyslipidemia consistently reported reductions in low-density lipoprotein cholesterol (LDL-C) and total cholesterol for several Lactobacillus strains, particularly L. paracasei and L. plantarum. No significant effects were identified for high-density lipoprotein cholesterol (HDL-C) or triglycerides. Mechanistic evidence indicates the involvement of bile salt hydrolase activity, modulation of apolipoproteins, and anti-inflammatory pathways. In summary, this integrated analysis demonstrates that Lactobacillus supplementation is associated with LDL-C reduction ranging from approximately 2.16 to 28.2 mg/dL, with a favorable safety profile, and represents a promising adjunctive strategy for hypercholesterolemia. The results also highlight significant opportunities to strengthen global research collaboration.