Plant Sterols/Stanols: Do they have a Role in Current Cardiovascular Disease Prevention?

Authors

  • Theodosios D. Filippatos Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
  • Moses S. Elisaf Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece

DOI:

https://doi.org/10.6000/1929-5634.2015.04.01.1

Keywords:

Plant sterols, plant stanols, low-density lipoprotein cholesterol, triglycerides, high-density lipoprotein cholesterol, atherosclerosis, cardiovascular disease.

Abstract

Plant sterols/stanols inhibit cholesterol absorption in the gastrointestinal tract. The daily consumption of 2 g/day of plant sterols/stanols decreases low-density lipoprotein cholesterol (LDL-C) levels by approximately 10%. Plant sterols/stanols also reduce LDL-C levels when co-administered with statins, a fact useful for patients intolerable to high-dose statins. However, no randomized, controlled clinical trials have examined the clinical benefit of daily consumption of plant sterols/stanols. Furthermore, concerns regarding a possible atherogenic effect of plant sterols have been expressed. The use of plant sterols/stanols-enriched foods is a useful adjunct for hypercholesterolemic patients to achieve their LDL-C target, but we need more data to establish if this hypolipidemic effect results to reduced cardiovascular risk.

References

European Association for Cardiovascular Prevention and Rehabilitation, Reiner Z, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32: 1769-818. http://dx.doi.org/10.1093/eurheartj/ehr158 DOI: https://doi.org/10.1093/eurheartj/ehr158

Gylling H, Plat J, Turley S, et al. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis 2014; 232: 346-60. http://dx.doi.org/10.1016/j.atherosclerosis.2013.11.043 DOI: https://doi.org/10.1016/j.atherosclerosis.2013.11.043

Sanclemente T, Marques-Lopes I, Puzo J, et al. Role of naturally-occurring plant sterols on intestinal cholesterol absorption and plasmatic levels. J Physiol Biochem 2009; 65: 87-98. http://dx.doi.org/10.1007/BF03165972 DOI: https://doi.org/10.1007/BF03165972

Katan MB, Grundy SM, Jones P, et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 2003; 78: 965-78. http://dx.doi.org/10.1016/S0025-6196(11)63144-3 DOI: https://doi.org/10.4065/78.8.965

Abumweis SS, Barake R, Jones PJ. Plant sterols/stanols as cholesterol lowering agents: A meta-analysis of randomized controlled trials. Food Nutr Res 2008; 52. http://dx.doi.org/10.3402/fnr.v52i0.1811 DOI: https://doi.org/10.3402/fnr.v52i0.1811

Demonty I, Ras RT, van der Knaap HC, et al. Continuous dose-response relationship of the LDL-cholesterol-lowering effect of phytosterol intake. J Nutr 2009; 139: 271-84. http://dx.doi.org/10.3945/jn.108.095125 DOI: https://doi.org/10.3945/jn.108.095125

Musa-Veloso K, Poon TH, Elliot JA, et al. A comparison of the LDL-cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: results of a meta-analysis of randomized, placebo-controlled trials. Prostaglandins Leukot Essent Fatty Acids 2011; 85: 9-28. http://dx.doi.org/10.1016/j.plefa.2011.02.001 DOI: https://doi.org/10.1016/j.plefa.2011.02.001

Goldberg AC, Ostlund RE, Jr., Bateman JH, et al. Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs. Am J Cardiol 2006; 97: 376-9. http://dx.doi.org/10.1016/j.amjcard.2005.08.056 DOI: https://doi.org/10.1016/j.amjcard.2005.08.056

Scholle JM, Baker WL, Talati R, et al. The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: systematic review and meta-analysis. J Am Coll Nutr 2009; 28: 517-24. http://dx.doi.org/10.1080/07315724.2009.10719784 DOI: https://doi.org/10.1080/07315724.2009.10719784

Eussen SR, de Jong N, Rompelberg CJ, et al. Dose-dependent cholesterol-lowering effects of phytosterol/phytostanol-enriched margarine in statin users and statin non-users under free-living conditions. Public Health Nutr 2011; 14: 1823-32. http://dx.doi.org/10.1017/S1368980011000164 DOI: https://doi.org/10.1017/S1368980011000164

Derdemezis CS, Filippatos TD, Mikhailidis DP, et al. Review article: effects of plant sterols and stanols beyond low-density lipoprotein cholesterol lowering. J Cardiovasc Pharmacol Ther 2010; 15: 120-34. http://dx.doi.org/10.1177/1074248409357921 DOI: https://doi.org/10.1177/1074248409357921

Sialvera TE, Pounis GD, Koutelidakis AE, et al. Phytosterols supplementation decreases plasma small and dense LDL levels in metabolic syndrome patients on a westernized type diet. Nutr Metab Cardiovasc Dis 2012; 22: 843-8. http://dx.doi.org/10.1016/j.numecd.2010.12.004 DOI: https://doi.org/10.1016/j.numecd.2010.12.004

Gazi I, Tsimihodimos V, Filippatos T, et al. Concentration and relative distribution of low-density lipoprotein subfractions in patients with metabolic syndrome defined according to the National Cholesterol Education Program criteria. Metabolism 2006; 55: 885-91. http://dx.doi.org/10.1016/j.metabol.2006.02.015 DOI: https://doi.org/10.1016/j.metabol.2006.02.015

Hansel B, Nicolle C, Lalanne F, et al. Effect of low-fat, fermented milk enriched with plant sterols on serum lipid profile and oxidative stress in moderate hypercholesterolemia. Am J Clin Nutr 2007; 86: 790-6. DOI: https://doi.org/10.1093/ajcn/86.3.790

Filippatos TD, Elisaf MS. High density lipoprotein and cardiovascular diseases. World J Cardiol 2013; 5: 210-4. http://dx.doi.org/10.4330/wjc.v5.i7.210 DOI: https://doi.org/10.4330/wjc.v5.i7.210

Demonty I, Chan YM, Pelled D, et al. Fish-oil esters of plant sterols improve the lipid profile of dyslipidemic subjects more than do fish-oil or sunflower oil esters of plant sterols. Am J Clin Nutr 2006; 84: 1534-42. DOI: https://doi.org/10.1093/ajcn/84.6.1534

Ratnayake WM, L'Abbe MR, Mueller R, et al. Vegetable oils high in phytosterols make erythrocytes less deformable and shorten the life span of stroke-prone spontaneously hypertensive rats. J Nutr 2000; 130: 1166-78. DOI: https://doi.org/10.1093/jn/130.5.1166

Jones PJ, Raeini-Sarjaz M, Jenkins DJ, et al. Effects of a diet high in plant sterols, vegetable proteins, and viscous fibers (dietary portfolio) on circulating sterol levels and red cell fragility in hypercholesterolemic subjects. Lipids 2005; 40: 169-74. http://dx.doi.org/10.1007/s11745-005-1372-6 DOI: https://doi.org/10.1007/s11745-005-1372-6

de Jong A, Plat J, Mensink RP. Plant sterol or stanol consumption does not affect erythrocyte osmotic fragility in patients on statin treatment. Eur J Clin Nutr 2006; 60: 985-90. http://dx.doi.org/10.1038/sj.ejcn.1602409 DOI: https://doi.org/10.1038/sj.ejcn.1602409

Escola-Gil JC, Quesada H, Julve J, et al. Sitosterolemia: diagnosis, investigation, and management. Curr Atheroscler Rep 2014; 16: 424. DOI: https://doi.org/10.1007/s11883-014-0424-2

Fransen HP, de Jong N, Wolfs M, et al. Customary use of plant sterol and plant stanol enriched margarine is associated with changes in serum plant sterol and stanol concentrations in humans. J Nutr 2007; 137: 1301-6. DOI: https://doi.org/10.1093/jn/137.5.1301

Filippatos TD, Elisaf MS. Are Lower Levels of LDL-Cholesterol Really Better? Looking at the Results of IMPROVE-IT: Opinions of Three Experts - III. Hellenic J Cardiol 2015; 56: 7-9.

Downloads

Published

2015-04-04

How to Cite

Filippatos, T. D., & Elisaf, M. S. (2015). Plant Sterols/Stanols: Do they have a Role in Current Cardiovascular Disease Prevention?. Journal of Nutritional Therapeutics, 4(1), 1–3. https://doi.org/10.6000/1929-5634.2015.04.01.1

Issue

Section

Articles