Published online Aug 18, 2016. doi: 10.4254/wjh.v8.i23.961
Peer-review started: March 22, 2016
First decision: May 19, 2016
Revised: May 25, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: August 18, 2016
Core tip: The liver is considered the master piece in regulation of plasma cholesterol levels. Together with the intestine they control the influx and the efflux of cholesterol and biliary acids in the body. Cholesterol and its conversion into biliary acids are regulated by an extended network of enzymes and transporters that largely influence plasma cholesterol levels. The key regulators of cholesterol and biliary acids in liver and intestine are in turn affected by several factors including estrogens levels and more recently exercise training. Low estrogenic levels, such as seen in post-menopausal women, are associated with higher plasma cholesterol levels. In recent years more information has been accumulated on the extent to which low estrogenic levels, such as seen in an ovariectomized animal model, influence cholesterol and biliary metabolism at the molecular level. As an alternative to a deficiency in estrogens, exercise training has been reported to exert a beneficial effect on these key regulators of cholesterol and biliary acids.