The effects of plant stanol ester consumption on arterial stiffness and endothelial function in adults: a randomised controlled clinical trial

Abstract

BackgroundThe hypocholesterolemic effect of plant stanol ester consumption has been studied extensively, but its effect on cardiovascular health has been less frequently investigated. We studied the effects of plant stanol esters (staest) on arterial stiffness and endothelial function in adults without lipid medication.MethodsNinety-two asymptomatic subjects, 35 men and 57 women, mean age of 50.8±1.0 years (SEM) were recruited from different commercial companies. It was randomized, controlled, double-blind, parallel trial and lasted 6 months. The staest group (n=46) consumed rapeseed oil-based spread enriched with staest (3.0 g of plant stanols/d), and controls (n=46) the same spread without staest. Arterial stiffness was assessed via the cardio-ankle vascular index (CAVI) in large and as an augmentation index (AI) in peripheral arteries, and endothelial function as reactive hyperemia index (RHI). Lipids and vascular endpoints were tested using analysis of variance for repeated measurements.ResultsAt baseline, 28% of subjects had a normal LDL cholesterol level (≤3.0 mmol/l) and normal arterial stiffness (<8). After the intervention, in the staest group, serum total, LDL, and non-HDL cholesterol concentrations declined by 6.6, 10.2, and 10.6% compared with controls (p<0.001 for all). CAVI was unchanged in the whole study group, but in control men, CAVI tended to increase by 3.1% (p=0.06) but was unchanged in the staest men, thus the difference in the changes between groups was statistically significant (p=0.023). AI was unchanged in staest (1.96±2.47, NS) but increased by 3.30±1.83 in controls (p=0.034) i.e. the groups differed from each other (p=0.046). The reduction in LDL and non-HDL cholesterol levels achieved by staest was related to the improvement in RHI (r=−0.452, p=0.006 and −0.436, p=0.008).ConclusionsLowering LDL and non-HDL cholesterol by 10% with staest for 6 months reduced arterial stiffness in small arteries. In subgroup analyses, staest also had a beneficial effect on arterial stiffness in large arteries in men and on endothelial function. Further research will be needed to confirm these results in different populations.Trial registrationClinical Trials Register # NCT01315964

Serum proprotein convertase subtilisin/kexin type 9 concentration is not increased by plant stanol ester consumption in normo- to moderately hypercholesterolaemic non-obese subjects. The BLOOD FLOW intervention study

“…The study was a randomized, placebo-controlled, double-blind and parallel clinical intervention lasting for 6 months [17,18].…”

“…The test products were provided by Raisio Nutrition Ltd. The diet was monitored by 3-day food record kept at baseline and at the end of the study [17,18].…”

“…The detailed design, methods, baseline data [17] and the results of the intervention on serum lipids, arterial stiffness and endothelial function [18] have recently been published. In short, no inclusion or exclusion criteria for serum and lipoprotein lipids were set, but lipid-lowering medication or the consumption of nutrient supplements interfering with serum cholesterol level (red rice or berberine) were included as exclusion criteria.…”

Are plant sterols and plant stanols a viable future treatment for dyslipidemia?

“…endothelial dysfunction and arterial stiffness. In two recent large interventions, the results have varied from no effect to only slight beneficial effects in surrogate markers, but no harmful effects were recorded [16,17]. These results suggest that there is no final answer whether plant sterol/stanol consumption is associated with clinical outcome benefit.…”

The role of nutraceuticals in the prevention of cardiovascular disease

“…Studies have failed to demonstrate antihypertensive effects of sterols/stanols despite continuing treatment for a year or more (24,25). One recent study, which aimed to analyse the effect of plant stanol esters on arterial stiffness and endothelial function in adults also found no effect on measured blood pressure (26). Although the data are limited there appears to be no antihypertensive effects of these compounds in humans, neither is there any indication of adverse effects on blood pressure.…”