Jie Dong, Lei Chen, Nan Zheng, Ming Yang
Probiotics adjunctive to statins may modestly benefit lipid metabolism and reduce inflammatory and oxidative stress markers, based on a limited number of trials; tolerability appeared favorable in the single small trial that reported safety data, but this signal is preliminary. No direct plaque-stability endpoints were reported.
BACKGROUND: This systematic review and meta-analysis evaluated the effects of combining probiotics with statins on blood lipids, TMAO, and plaque stability in atherosclerotic patients.
METHODS: Literature was systematically searched in PubMed, Cochrane Library, Embase, and Web of Science through April 2026. Eligible studies were assessed for quality using Cochrane Risk of Bias 2.0 and GRADE. Data synthesis was performed with R software.
RESULTS: Five studies (n = 1,034) were included, with two RCTs (n = 113) evaluating probiotic plus statin therapy. Combined therapy did not significantly enhance LDL-C reduction compared to statin alone (MD = 0.30 mmol/L, 95% CI: -0.37, 0.97). Probiotics significantly reduced TNF-α (-1.51 vs. +1.43 pg/mL, P < 0.05) and MDA (P < 0.001). Adverse events were lower in the combined group (15.7% vs. 25%; RR = 0.67).
CONCLUSIONS: Probiotics adjunctive to statins may modestly benefit lipid metabolism and reduce inflammatory and oxidative stress markers, based on a limited number of trials; tolerability appeared favorable in the single small trial that reported safety data, but this signal is preliminary. No direct plaque-stability endpoints were reported.