Cholesterol plays a major role in human health. High cholesterol is a leading risk factor for human cardiovascular disease such as atherosclerosis, coronary heart disease, and stroke. Excess cholesterol in the bloodstream can form plaque in the artery walls. Hypercholesterolemia is a major risk factor for the development of atherosclerosis. A number of pharmacological and non-pharmacological (including dietary) approaches being employed to reduce the cholesterol level. Numerous drugs that lower serum cholesterol have been developed to treat hypercholesterolemic patients, the best example being the statins drugs (Atorvastatin, Simvastatin, Rosuvastatin, and Lovastatin). However, the undesirable side effects of these compounds were observed and have caused concern about their long term therapeutic use. Several studies have been reported that the consumption of fermented dairy products decreases serum cholesterol. Probiotics are live microorganisms that promote health benefits upon consumption, while prebiotics are nondigestible food ingredients that selectively stimulate the growth of beneficial microorganisms in the gastrointestinal tract. Probiotics and prebiotics have been suggested to reduce cholesterol via various mechanisms without any deleterious effect to the human health. This paper may throw some light to prove the ability of these synbiotics as a novel alternative or adjuvant to chemical drugs to help fight the hypercholesterolemic problem. 1. Introduction Elevated serum cholesterol level is widely recognized as a contributory risk factor for the development of cardiovascular diseases (CVD) such as atherosclerosis, coronary heart diseases, and hypertension. The World Health Organization (WHO) has predicted that by 2030, CVD will remain the leading cause of death and will affect approximately 23.6 million people globally [1]. It has been reported that even a 1% reduction in serum cholesterol could reduce the risk of coronary heart disease by 2-3% [2]. Hypercholesterolemia contributed to 45% of heart attacks in Western Europe and 35% of heart attacks in Central and Eastern Europe from 1999 to 2003 [3, 4]. The risk of heart attack is three times higher in those with hypercholesterolemia, compared to those who have normal blood lipid profiles. The WHO delineated that unhealthy diets such as those high in fat, salt, and free sugar and low in complex carbohydrates lead to an increased risk of cardiovascular diseases [5]. 1.1. Good and Bad Cholesterol Cholesterol is a waxy, fat-like substance found in the body cells of humans and animals. Sometimes
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