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Improvement of cholesterol levels and reduction of cardiovascular risk via the consumption of phytosterols

Published online by Cambridge University Press:  08 March 2007

Rosa M. Ortega ,
Ana Palencia  and
Ana M López-Sobaler
Rosa M. Ortega*
Affiliation:
Departamento de Nutrición, Facultad de Farmacia, Universidad Complutense de Madrid, E-28040 Madrid, Spain
Ana Palencia
Affiliation:
Unilever Foods España, División Alimentación, Spain
Ana M López-Sobaler
Affiliation:
Departamento de Nutrición, Facultad de Farmacia, Universidad Complutense de Madrid, E-28040 Madrid, Spain
*
*Corresponding author: Dr Rosa M. Ortega, fax +34 1 3941810, email rortega@farm.ucm.es
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Abstract

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Hypercholesterolaemia is one of the main factors contributing to the appearance and progression of CVD, which is the main cause of death in the adult population of industrialized societies. By 2020, projections suggest that it will continue to hold first place, by then causing 37 % of all deaths. Therapeutic life-style changes to reduce cardiovascular risk include dietary modifications, such as the inclusion of phytosterols or plant sterols (known since the 1950s to reduce cholesterol levels). These help prevent the absorption of cholesterol and thus condition a reduction in total cholesterol and LDL-cholesterol levels, and ultimately in cardiovascular mortality. The fat-soluble nature of these sterols rendered margarine one of the best vehicles by which to supply them in the diet. Indeed, margarine was the first food to contain cholesterol-reducing phytosterols to be approved by the EU (in agreement with its regulations on new foods and food ingredients, 258/97/CE). Presently, phytosterols can be emulsified with lecithin and thus delivered in non-fat or low-fat foods and beverages. Margarine and dairy products (yoghurt and milk) enriched in phytosterols have proved better at lowering total cholesterol and LDL-cholesterol levels than have enriched cereals and their derivatives, although all can be of help, depending on the characteristics of each subject. The reduction in carotenoid bioavailability caused by sterols is minimized by increasing fruit and vegetable consumption. Individuals who habitually consume phytosterols should also follow traditional advice such as eating less dietary fat and increasing their physical activity. Phytosterols have been shown to be safe and effective in lowering cholesterol levels in many rigorous studies. In few areas of nutrition is there such consensus. Diet professionals should feel comfortable in prescribing phytosterols/stanols for the treatment of hypercholesterolaemia. They are safe whether taken alone or in combination with cholesterol-reducing drugs, such as statins and fibrates. Reinforcement counselling is essential, as therapy is effective only if compliance is good.

Keywords

Plant sterolsCholesterolLDL-cholesterolCardiovascular disease
Type
Research Article
Information
British Journal of Nutrition , Volume 96 , Issue S1 , August 2006 , pp. S89 - S93
Copyright
Copyright © The Nutrition Society 2006

References

Amundsen, ÅL, Ntanios, F, van der Put, N, Ose, L (2004) Long-term compliance and changes in plasma lipids, plant sterols and carotenoids in children and parents with FH consuming plant sterol ester-enriched spread. Eur J Clin Nutr 58, 1612–1620.CrossRefGoogle ScholarPubMed
Cleghorn, CL, Skeaff, CM, Mann, J & Chisholm, A (2003) Plant sterol-enriched spread enhances the cholesterol-lowering potential of a fat-reduced diet. Eur J Clin Nutr 57, 170–176.CrossRefGoogle ScholarPubMed
Clifton, PM, Noakes, M & Sullivan, D (2004) Cholesterol-lowering effects of plant sterol esters differ in milk, yoghurt, bread and cereal. Eur J Clin Nutr 58, 503–509.CrossRefGoogle ScholarPubMed
Colgan, HA, Floyd, S, Noone, EJ, Gibney, MJ & Roche, HM (2004) Increased intake of fruit and vegetables and low-fat diet, with and without low-fat plant sterol-enriched spread consumption: effects on plasma lipoprotein and carotenoid metabolism. J Hum Nutr Diet 17, 561–569.CrossRefGoogle ScholarPubMed
Food and Drug Administration (2000) Food labeling: health claims; plant sterol/stanol esters and coronary heart disease. Food Drug Adm Fed Reg 65, 54686–54739.Google Scholar
Jenkins, DJA, Kendall, CWC & Marchie, A (2005) Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr 81, 380–387.CrossRefGoogle ScholarPubMed
Law, M (2000) Plant sterol and stanol margarines and health. BMJ 320, 861–864.Google Scholar
Miettinen, TA & Gylling, H (2004) Plant stanol and sterol esters in prevention of cardiovascular diseases. Ann Med 36, 126–134.CrossRefGoogle ScholarPubMed
Noakes, M, Clifton, P, Ntanios, F, Shrapnel, W, Record, I & McInerney, J (2002) An increase in dietary carotenoids when consuming plant sterols or stanols is effective in maintaining plasma carotenoid concentrations. Am J Clin Nutr 75, 79–86.Google Scholar
Ostlund, RE Jr (2004) Phytosterols and cholesterol metabolism. Curr Opin Lipidol 15, 37–41.CrossRefGoogle ScholarPubMed
Patch, CS, Tapsell, LC & Williams, PG (2005) Plant sterol/stanol prescription is an effective treatment strategy for managing hypercholesterolemia in outpatient clinical practice. J Am Diet Assoc 105, 46–52.CrossRefGoogle ScholarPubMed
Perisee, DM (2005) Food fortification with plant sterol/stanol for hyperlipidemia: management in free-living populations. J Am Diet Assoc 105, 52–53.CrossRefGoogle ScholarPubMed
Thomsen, AB, Hansen, HB, Christiansen, C, Green, H & Berger, A (2004) Effect of free plant sterols in low-fat milk on serum lipid profile in hypercholesterolemic subjects. Eur J Clin Nutr 58, 860–870.CrossRefGoogle ScholarPubMed
US Department of Health and Human Services (2001) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): executive summary of the third report of the National Cholesterol Education Program (NCEP). JAMA 28, 2486–2497.Google Scholar
Varady, KA, Ebine, N, Vanstone, CA, Parsons, WE & Jones, PJ (2004) Plant sterols and endurance training combine to favorably alter plasma lipid profiles in previously sedentary hypercholesterolemic adults after 8 wk. Am J Clin Nutr 80, 1159–1166.CrossRefGoogle Scholar