Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease

Abstract

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.

Are plant sterols and plant stanols a viable future treatment for dyslipidemia?

“…The absorption efficiency of plant sterols is less than 2% and that of plant stanols less than 0.2% [1]. Consequently, the circulating serum levels of plant sterols and stanols are very low compared to serum cholesterol concentration, so that serum total plant sterol concentrations are <24 µmol/l (1.0 mg/dl), and serum total plant stanol concentrations are even lower, <0.7 µmol/l (0.028 mg/dl) [2].…”

“…The most recent meta-analysis consisting of 124 randomized controlled clinical studies in adults demonstrated a dose-response effect between the amount of consumed plant sterols/stanols and LDL-C lowering, so that increasing the plant sterol/stanol intake from 0.6 g/day to 3.3 g/day LDL-C was lowered from 6% to 12% [12]. Plant sterols/stanols in general do not affect high-density lipoprotein (HDL) cholesterol or serum triglyceride concentrations, but they decrease serum non-HDL cholesterol concentration, they have no effect on serum inflammation markers [2] or on serum proprotein convertase subtilisin/kexin type 9 concentration [13]. They are well tolerated, and there is a large body of information regarding them safe in long-term use [2].…”

“…Plant sterols/stanols in general do not affect high-density lipoprotein (HDL) cholesterol or serum triglyceride concentrations, but they decrease serum non-HDL cholesterol concentration, they have no effect on serum inflammation markers [2] or on serum proprotein convertase subtilisin/kexin type 9 concentration [13]. They are well tolerated, and there is a large body of information regarding them safe in long-term use [2].…”

β-Cryptoxanthin modulates the response to phytosterols in post-menopausal women carrying NPC1L1 L272L and ABCG8 A632 V polymorphisms: an exploratory study

“…Phytosterol (PS) intake may be used for hypercholesterolaemia in some groups since they reduce serum levels of LDL cholesterol (c-LDL) (Gylling et al 2014). Different studies show that a daily intake of 1.6-2 g/day can reduce intestinal cholesterol absorption by about 30 % and plasma c-LDL levels by 8-10 % (Marangoni and Poli 2010;Ras et al 2013).…”

Immune Modulation of Aloe vera: Acemannan and Gut Microbiota Modulator

“…However, it must be acknowledged that there are no randomised, controlled clinical trial data with hard endpoints to establish clinical benefit from the use of pant sterols or plant stanols [49] . The EAS consensus panel critically apprised 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 LDL-C levels and thereby lower cardiovascular risk.…”