Effects of plant sterol and stanol ester consumption on lipid metabolism, antioxidant status and markers of oxidative stress, endothelial function and low-grade inflammation in patients on current statin treatment

Abstract

Objective: The present study was designed to examine for the first time, side-by-side, the effects of plant sterol and stanol consumption on lipid metabolism and markers of antioxidant status, oxidative stress, endothelial dysfunction and low-grade inflammation in subjects on stable statin-treatment. Design: Double-blind, randomized, placebo-controlled, intervention trial. Setting: University. Subjects: Forty-five patients on current statin treatment were recruited via newspaper advertisements. Data of 41 patients were used in statistical analysis. Intervention: Subjects consumed margarine with no added plant sterols or stanols for 4 weeks and were then divided into three groups of 15 subjects. For the next 16 weeks, one group continued with the control margarine and the other two groups with either a plant sterol-or stanol (2.5 g/day)-enriched margarine. Blood was sampled at the end of the run-in and intervention periods. Results: Plant sterol and stanol consumption significantly (P ¼ 0.026) reduced low-density lipoprotein (LDL) cholesterol by 0.34 mmol/l (95% confidence interval (CI), À0.67 to À0.04 mmol/l). No effects were shown on enzymatic and non-enzymatic antioxidants and markers of oxidative modification of lipids and DNA. In addition, no effect was found on soluble adhesion molecules, C-reactive protein and monocyte chemotactic protein-1 concentrations. Conclusions: We conclude that 16 weeks of plant sterol or stanol consumption did not affect markers of antioxidant status, oxidative stress, endothelial dysfunction and low-grade inflammation in patients on stable statin treatment, despite a significant reduction of LDL cholesterol.

Phytosterols: natural compounds with established and emerging health benefits

“…Human studies have not demonstrated yet clear possible benefits of phytosterols on other risk factors related to the development of atherosclerosis besides the substantial reduction of total and LDL-cholesterol. For instance, coagulation and fibrinolytic parameters as well as endothelial markers like vascular cell adhesion molecule 1 (VCAM) and intercellular adhesion molecule 1 (ICAM) were not significantly affected after plant sterol or stanol intake for up to 16 weeks [56,57]. In studies with children with familiar hypercholesterolemia, short-term phytosterol intake did not improve endothelial dysfunction as measured by flow-mediated dilation (FMD) despite the clear reduction in LDL-cholesterol [58].…”

Support of drug therapy using functional foods and dietary supplements: focus on statin therapy

“…The results for total cholesterol were statistically significant for five out of seven studies (36 -40) , and either borderline significant (P¼0·052) (41) or non-significant (42) for the two remaining studies. Reductions in LDL-cholesterol were not significantly different between the intervention and control group only in a single-blind study performed by Castro Cabezas et al (42) .…”

“…1·8 g soya stanol per d in tablets (n 13)/P: starch-containing tablets (n 13) (41) DB, PC, R 4 HC on statin therapy (n 41) 2·5 g plant stanol (n 15) or sterol ester per d in spread (n 15)/P: 'light' spread (n 11)…”

Scientific Opinion on the substantiation of a health claim related to 3 g/day plant sterols/stanols and lowering blood LDL-cholesterol and reduced risk of (coronary) heart disease pursuant to Article 19 of Regulation (EC) No 1924/2006

“…Based on data from 14 studies with 531 subjects, plant sterols and plant stanols at intakes ranging from 1.5 to 3.0 g/d in matrices approved by Regulation (EC) No 376/2010 (yellow fat spreads, dairy products, mayonnaise and salad dressings) were statistically not significantly different in lowering total cholesterol (difference: -1.11 mg/dL; 95 % CI: -4.12 to 1.90; p = 0.47) and LDL-cholesterol (difference: -0.35 mg/dL; 95 % CI: -2.98 to 2.28; p = 0.79). Four studies included in this metaanalysis used intakes higher than 2 g/d (but not exceeding 3 g/d) and showed comparable effects in lowering total and LDL-cholesterol for plant sterols and stanols without evidence for a difference in the efficacy between sterols and stanols (de Jong et al 2008a;Nestel et al 2001;Noakes et al 2002;Weststrate et al 1998). …”