Plant sterols lower LDL cholesterol without improving endothelial function in prepubertal children with familial hypercholesterolaemia

Abstract

In adults with familial hypercholesterolaemia (FH), cholesterol lowering with statins has been shown to improve the endothelial function, a hallmark of early atherogenesis. Currently, therapeutic options for treating high cholesterol levels in FH children are limited. Plant sterols safely and effectively reduce serum cholesterol concentrations by inhibiting cholesterol absorption. Therefore, we evaluated the effect of plant sterols on cholesterol and vascular function in prepubertal children with FH. We included 41 children (5-12 years old) with FH in a double-blind crossover trial using spreads containing 2.3 g of plant sterols (mainly sitosterol and campesterol) per 15 g spread and a placebo spread for a 4-week period, separated by a 6-week washout period. Lipid levels and endothelial function were assessed after both 4-week treatment periods. Endothelial function was assessed as flow-mediated dilation (FMD) of the brachial artery using a wall tracking system. Data were compared to those of 20 healthy controls. Intake of 2.3 g plant sterols per day decreased total cholesterol (-11%) and low-density cholesterol (-14%) as compared to placebo spread in FH children. FH children treated with placebo spread were characterized by an impaired FMD compared to healthy control children (7.2% +/- 3.4% versus 10.1% +/- 4.2%, p < 0.005). However, the reduction of LDL in FH children did not improve FMD (placebo: 7.2% +/- 3.4% versus plant sterols: 7.7% +/- 4.1%). In conclusion, the present study shows a clear reduction of LDL cholesterol by plant sterol treatment. However, short-term plant sterol treatment does not improve the endothelial function in FH children.

Effect of a plant sterol, fish oil and B vitamin combination on cardiovascular risk factors in hypercholesterolemic children and adolescents: a pilot study

“…Reductions in the LDL-cholesterol levels by 8.7% in the group of 15 adolescents aged over 17 years and by 9.5% in the group of 10 children aged 10 to 16 years were observed. The results are in line with previous studies on the use of plant sterols and stanols in children and adolescents with hypercholesterolemia with the significant LDL-cholesterol reduction observed in range of 9 to 15% with daily intake ranging from 1.2 to 3 g of plant sterol or stanols [5-7,20,21]. It has been proposed that the mechanism of such cholesterol lowering involves competition between intestinal plant sterols/stanols and intestinal cholesterol for absorption in mixed micelles and upregulation of the enterocyte ATP-binding cassette transport proteins [22].…”

“…The intakes of plant sterol/stanol esters can reduce blood LDL-cholesterol levels in children with familial hypercholesterolemia [5-7]. The European Food Safety Authority (EFSA) has approved the daily intake of 1.5 – 2.4 g of plant sterol/stanol esters to achieve a blood LDL-cholesterol reduction of 7-10.5% in 2-3 weeks in an adult population [8].…”

Modulation of the effects of chylomicron remnants on endothelial function by minor dietary lipid components

“…de Jongh et al [41] administrated a mixture of phytosterols (β-sitosterol, campesterol, stigmasterol and others) to 41 children with familial hypercholesterolaemia, finding a reduction in LDL-cholesterol but no effect on endothelial dysfunction as measured by flow-mediated dilation. However, Moreno [42] incubated PMA-stimulated RAW 264.7 macrophages with β-sitosterol, and observed a reduction in ROS (reactive oxygen species) production and AA release (Figure 1).…”

Cardiovascular Disease Prevention: The Earlier the Better? A Review of Plant Sterol Metabolism and Implications of Childhood Supplementation

“…The rationale for such recommendations is not entirely clear. The efficacy of plant sterols to reduce LDL-C during youth has been shown by a considerable number of studies, when both normolipidemic and hyperlipidemic children aged 4-19 years receiving 1.2-3 g/day of plant sterols/stanols showed the same rate of LDL-C reduction as seen in adults (5%-20%) [7,[77][78][79][80][81][82][83]85,86].…”

“…de Jongh et al (2003) [81] Double-blind crossover trial using plant sterol enriched spreads and a placebo spread. Forty-one children (aged 5-12 years) with familial hypercholesterolemia (FH) were included in this study.…”