Knowledge as to cholesterol reduction and use of phytosterol-enriched dietary foods in the general population: Insights from the Hamburg City Health Study

The Effect of Dietary Supplementation with Plant Sterols on Total and LDL-Cholesterol in Plasma Is Affected by Adherence to Mediterranean Diet: Insights from the DESCO Randomized Clinical Study

“…A possible explanation of this observation might be the larger quantity of polyphenols usually found in the Mediterranean diet [39,40]. Since these compounds have been shown to exert a slight inhibition of cholesterol synthesis due to the inhibition of HMGCoA reductase, their effect might theoretically potentiate the hypocholesterolemic effects of phytosterols acting on cholesterol absorption from the gut [39,40] Our preliminary observation of a potential additive effect of plant sterol efficacy from good adherence to the Mediterranean diet is also useful considering that the Mediterranean diet per se has proven to be an effective means to prevent ASCVD [11,41]. In fact, compared to different healthy dietary approaches, it has been estimated that the Mediterranean diet is associated with a significant reduction in the risk of cardiovascular mortality (odds ratio 0.55, 95% CI 0.39 to 0.78), stroke (odds ratio 0.65, 95% CI 0.46 to 0.93), and non-fatal myocardial infarction (odds ratio 0.48, 95% CI 0.36 to 0.65) [42].…”

“…The latest International guidelines of the European Society of Cardiology (ESC) and the European Society of Atherosclerosis (EAS) recommend the daily consumption of functional food with 2 g of plant sterols/stanols (i) in individuals at low or intermediate CV risk and high cholesterol levels who do not qualify for pharmacotherapy according to their global CV risk; (ii) in addition to pharmacotherapy in high and very high risk patients who failed to achieve LDL-C-goals on statins or who cannot be treated with statins; and (iii) in individuals with familial hypercholesterolemia (FH) [9,10]. Interestingly, insights from the Hamburg City Health Study (n = 7223) highlight a trend toward the use of phytosterol-enriched products by individuals at increased CV risk independent of income [11]. However, a dose-effect relationship of plant stanols in higher doses than currently recommended by the international guidelines has been demonstrated by several clinical studies and a comprehensive meta-analysis [12].…”