Phytosterols, Cholesterol Control, and Cardiovascular Disease

Abstract

The use of phytosterols (or plant sterols) for the control of plasma cholesterol concentrations has recently gained traction because their efficacy is acknowledged by scientific authorities and leading guidelines. Phytosterols, marketed as supplements or functional foods, are formally classified as food in the European Union, are freely available for purchase, and are frequently used without any health professional advice; therefore, they are often self-prescribed, either inappropriately or in situations in which no significant advantage can be obtained. For this reason, a panel of experts with diverse medical and scientific backgrounds was convened by NFI—Nutrition Foundation of Italy—to critically evaluate and summarize the literature available on the topic, with the goal of providing medical doctors and all health professionals useful information to actively govern the use of phytosterols in the context of plasma cholesterol control. Some practical indications to help professionals identify subjects who will most likely benefit from the use of these products, optimizing the therapeutic outcomes, are also provided. The panel concluded that the use of phytosterols as supplements or functional foods to control Low Density Lipoprotein (LDL) cholesterol levels should be preceded by the assessment of some relevant individual characteristics: cardiovascular risk, lipid profile, correct understanding of how to use these products, and willingness to pay for the treatment.

Therapeutic Properties and Use of Extra Virgin Olive Oil in Clinical Nutrition: A Narrative Review and Literature Update

“…Afterward, phytosterols are then esterified within enterocytes and incorporated in chylomicrons to reach the liver. Finally, hepatocytes secrete these phytosterols into the bile through ABCG5/G8 transporters [ 126 ]. Phytosterol composition, the characteristics of its food matrix, clinical conditions that affect cholesterol metabolism such as type 2 diabetes mellitus (DM2), and single-nucleotide polymorphisms (SNPs) in NPC1L1 and apolipoprotein E (ApoE) may modify both their bioavailability and their efficacy [ 126 , 127 ].…”

“…Beneficial effects of phytosterols on LDL-cholesterol are well established, with a mean reduction of 8–10% [ 294 ] and significant reductions in ApoCII and ApoE [ 295 ]. An extensive review of clinical trials with phytosterols in cardiovascular risk reduction was published elsewhere [ 126 ]. There is no definitive evidence on the impact of dividing the daily phytosterol intake on cholesterol metabolism [ 296 , 297 ]; therefore, further studies are needed to make recommendations.…”

The Role of Phytosterols in Nonalcoholic Fatty Liver Disease

“…After being transported to the liver, PSs can return to the intestine via ABC from the hepatobiliary interface [ 26 ]. There are those who have shown that the administration of PSs has led to a decrease in total cholesterol and LDL cholesterol by decreasing the absorption of cholesterol from the diet and the action on the intestinal and hepatic mechanisms [ 36 ].…”

Using Nutraceuticals and Functional Foods to Modulate Cholesterol Concentrations

“…Plant sterols and stanols (collectively known as phytosterols) have a polycyclic chemical structure similar to that of cholesterol with the exception of the side chain linked to the cyclopentane ring (19). They are almost absent in animal-based foods, but are found (in assorted amounts) in all plant-based products (20).…”