Plant sterols for adults with hypercholesterolemia treated with or without medication (statins)

Abstract

Hypercholesterolemia is the most common coronary risk factor among the Spanish population; 37.4% of the Spanish adult population have cholesterol levels between 190 and 240 mg/dl. Foods enriched with plant sterols (PS) can effectively reduce plasma cholesterol in patients with high levels. However, its effectiveness and safety in adults with moderate hypercholesterolemia who are on medication (statins) or not has been less studied. The aim of this review is to establish the possible role of plant sterols in the control of hypercholesterolemia, as well as how safe they are for people with moderate hypercholesterolemia treated with statins. The main studies were looked at, regardless of design, language or publication date which studied the connection between "plant sterols" and "hypercholesterolemia", using Pubmed/Medline, SCOPUS and Google Scholar databases. The studies brought together in this review show that an intake of between 2 and 3g/day of plant sterols effectively reduces plasma cholesterol levels in patients with hypercholesterolemia. Both clinical studies and available meta-analyses do not indicate any problems related to the drug-nutrient interaction associated with the use of plant sterol-enriched foods. In patients with moderate hypercholesterolemia where the use of statins is not justified a healthy diet, exercise and foods high in PS can provide the best therapeutic approach. La hipercolesterolemia es el factor de riesgo cardiovascular más frecuente en la población española. El 37,4% de la población adulta española presenta niveles de colesterol de entre 190 y 240 mg/dl. Los alimentos enriquecidos con esteroles vegetales (EV) pueden disminuir de forma efectiva el colesterol plasmático en pacientes con niveles elevados, sin embargo su efecto y seguridad en adultos con hipercolesterolemia moderada, tratados o no con fármacos (estatinas) ha sido menos estudiada. El objetivo de la presente revisión es establecer el posible papel de los esteroles vegetales en el control de la hipercolesterolemia, así como su seguridad en personas con hipercolesterolemia moderada tratada con estatinas. Se revisaron los principales estudios, sin limitación de diseño, lengua o fecha de publicación que relacionara "esteroles vegetales" e "hipercolesterolemia", explotando las bases de datos Pubmed/Medline, SCOPUS y Google Scholar. Los estudios recuperados en la presente revisión muestran que el aporte de entre 2 y 3g/día de esteroles vegetales disminuyen de forma efectiva los niveles de colesterol plasmático en pacientes con hipercolesterolemia. Tanto los estudios clínicos como los metaanálisis disponibles no muestran problemas relacionados con la interacción fármaco-nutriente asociada al uso de alimentos enriquecidos con EV. En pacientes con hipercolesterolemia moderada en que no esté justificado el uso de estatinas, una alimentación saludable, actividad física y alimentos con EV, puede constituir el mejor acercamiento terapéutico. PALABRAS CLAVE

Minor lipid metabolic perturbations in the liver of Atlantic salmon (Salmo salar L.) caused by suboptimal dietary content of nutrients from fish oil

“…The dietary supply of some lipid-soluble vitamins and cholesterol is also reduced in VO-based diets, while the dietary content of plant sterols (phytosterols) is increased. Phytosterols have the ability to inhibit the uptake of cholesterol from the intestine and lower plasma cholesterol and triacylglycerol (TAG) in humans (Bernacer et al 2015). The effects of phytosterols on Atlantic salmon metabolism and health are not completely known, but it has been suggested that high concentrations of dietary phytosterols ([1.1 g kg -1 diet) can lead to some unwanted metabolic changes, like increased liver and plasma TAGs (Liland 2014).…”