TY - JOUR
T1 - Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease
AU - Gylling, Helena
AU - Plat, Jogchum
AU - Turley, Stephen
AU - Ginsberg, Henry N.
AU - Ellegård, Lars
AU - Jessup, Wendy
AU - Jones, Peter J.
AU - Lütjohann, Dieter
AU - Maerz, Winfried
AU - Masana, Luis
AU - Silbernagel, Günther
AU - Staels, Bart
AU - Borén, Jan
AU - Catapano, Alberico L.
AU - De Backer, Guy
AU - Deanfield, John
AU - Descamps, Olivier S.
AU - Kovanen, Petri T.
AU - Riccardi, Gabriele
AU - Tokgözoglu, Lale
AU - Chapman, M. John
PY - 2014/2
Y1 - 2014/2
N2 - Objective: This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk. Methods and results: Plant sterols/stanols (when taken at 2g/day) cause significant inhibition of cholesterol absorption and lower LDL-C levels by between 8 and 10%. The relative proportions of cholesterol versus sterol/stanol levels are similar in both plasma and tissue, with levels of sterols/stanols being 500-/10,000-fold lower than those of cholesterol, suggesting they are handled similarly to cholesterol in most cells. Despite possible atherogenicity of marked elevations in circulating levels of plant sterols/stanols, protective effects have been observed in some animal models of atherosclerosis. Higher plasma levels of plant sterols/stanols associated with intakes of 2g/day in man have not been linked to adverse effects on health in long-term human studies. Importantly, at this dose, plant sterol/stanol-mediated LDL-C lowering is additive to that of statins in dyslipidaemic subjects, equivalent to doubling the dose of statin. The reported 6-9% lowering of plasma triglyceride by 2g/day in hypertriglyceridaemic patients warrants further evaluation. Conclusion: Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are no randomised, controlled clinical trial data with hard end-points to establish clinical benefit from the use of plant sterols or plant stanols.
AB - Objective: This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk. Methods and results: Plant sterols/stanols (when taken at 2g/day) cause significant inhibition of cholesterol absorption and lower LDL-C levels by between 8 and 10%. The relative proportions of cholesterol versus sterol/stanol levels are similar in both plasma and tissue, with levels of sterols/stanols being 500-/10,000-fold lower than those of cholesterol, suggesting they are handled similarly to cholesterol in most cells. Despite possible atherogenicity of marked elevations in circulating levels of plant sterols/stanols, protective effects have been observed in some animal models of atherosclerosis. Higher plasma levels of plant sterols/stanols associated with intakes of 2g/day in man have not been linked to adverse effects on health in long-term human studies. Importantly, at this dose, plant sterol/stanol-mediated LDL-C lowering is additive to that of statins in dyslipidaemic subjects, equivalent to doubling the dose of statin. The reported 6-9% lowering of plasma triglyceride by 2g/day in hypertriglyceridaemic patients warrants further evaluation. Conclusion: Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are no randomised, controlled clinical trial data with hard end-points to establish clinical benefit from the use of plant sterols or plant stanols.
KW - Cardiovascular risk
KW - Functional foods with added plant sterols and plant stanols
KW - Hypercholesterolaemia
KW - Intestinal cholesterol absorption
KW - Phytosterols
KW - Safety
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U2 - 10.1016/j.atherosclerosis.2013.11.043
DO - 10.1016/j.atherosclerosis.2013.11.043
M3 - Review article
C2 - 24468148
AN - SCOPUS:84892882894
SN - 0021-9150
VL - 232
SP - 346
EP - 360
JO - Atherosclerosis
JF - Atherosclerosis
IS - 2
ER -