PLANT STEROLS
letteratura - references

 

J Nutr. 2009 May 20.

Consuming Functional Foods Enriched with Plant Sterol or Stanol Esters for 85 Weeks Does Not Affect Neurocognitive Functioning or Mood in Statin-Treated Hypercholesterolemic Individuals.
Schiepers OJ, de Groot RH, van Boxtel MP, Jolles J, de Jong A, Lütjohann D, Plat J, Mensink RP.
School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology.
Recent animal and human studies have shown that plant sterols and stanols, which are used as functional food ingredients to lower increased LDL cholesterol concentrations, pass the blood-brain barrier. Whether this affects neurocognitive functioning and mental well-being in humans has, to our knowledge, never been investigated. The aim of the present study was therefore to examine the effects of long-term plant sterol or stanol consumption on neurocognitive functioning and mood in a randomized, double-blind, placebo-controlled dietary intervention trial. To this end, hypercholesterolemic individuals, aged 43-69 y, receiving stable statin treatment were randomly assigned to an 85-wk supplementation with margarines enriched with plant sterol esters (2.5 g/d), plant stanol esters (2.5 g/d), or placebo. At baseline and at the end of the intervention period, all participants underwent a cognitive assessment. In addition, subjective cognitive functioning and mood were assessed by means of questionnaires (Cognitive Failure Questionnaire and depression subscale of the Symptom Checklist 90, respectively). Long-term supplementation with plant sterol or stanol esters did not affect cognitive performance (memory, simple information processing speed, complex information processing speed, Letter-Digit Substitution test performance), subjective cognitive functioning, or mood. In conclusion, the present results indicate that long-term use of plant sterols or stanols at recommended intakes of 2.5 g/d does not affect neurocognitive functioning or mood in hypercholesterolemic individuals receiving statin treatment.

 

Ann Intern Med. 2009 Apr 7;150(7):474-84.
Systematic review: association of low-density lipoprotein subfractions with cardiovascular outcomes.
Ip S, Lichtenstein AH, Chung M, Lau J, Balk EM.
Tufts Medical Center and Tufts University, Boston, Massachusetts 02111, USA.
BACKGROUND: Measures of low-density lipoprotein (LDL) subfractions have been proposed as an independent risk factor for cardiovascular disease. PURPOSE: To review published studies that reported relationships between LDL subfractions and cardiovascular outcomes. DATA SOURCES: MEDLINE (1950 to 5 January 2009), CAB Abstracts (1973 to 30 June 2008), and Cochrane Central Register of Controlled Trials (2nd quarter of 2008), limited to English-language studies. STUDY SELECTION: 3 reviewers selected longitudinal studies with 10 or more participants that reported an association between LDL subfractions and incidence or severity of cardiovascular disease and in which plasma samples were collected before outcome determination. DATA EXTRACTION: Data were extracted from 24 studies. The 10 studies that used analytical methods available for clinical use (all of which used nuclear magnetic resonance) had full data extraction, including quality assessment (good, fair, or poor). All studies were extracted by 1 researcher and verified by another. DATA SYNTHESIS: All 24 studies, and the subset of 10 nuclear magnetic resonance studies, were heterogeneous in terms of the specific tests analyzed, analytical methods used, participants investigated, and outcomes measured. Higher LDL particle number was consistently associated with increased risk for cardiovascular disease, independent of other lipid measurements. Other LDL subfractions were generally not associated with cardiovascular disease after adjustment for cholesterol concentrations. No study evaluated the incremental value of LDL subfractions beyond traditional cardiovascular risk factors or their test performance. Limitation: Publication bias was a possibility. CONCLUSION: Higher LDL particle number has been associated with cardiovascular disease incidence, but studies have not determined whether any measures of LDL subfractions add incremental benefit to traditional risk factor assessment. Routine use of clinically available LDL subfraction tests to estimate cardiovascular disease risk is premature.

 

Diabetes Educ. 2009 Apr 6.
Nutrition Evidence-Based Guidelines for Treating Hyperlipidemia in Children With Type 1 Diabetes: A Case Presentation.
Robinson M.
Children's Hospital of Philadelphia.
Purpose The purpose of this case presentation is to review the current nutrition evidence-based guidelines and treatment goals for hyperlipidemia in children with type 1 diabetes. The American Heart Association (AHA) places children with type 1 diabetes in the highest tier for cardiovascular risk. Methods Early screening for hyperlipidemia in children with diabetes is recommended to identify those children at risk. If the fasting low-density lipoprotein cholesterol (LDL-C) level is >/=100 mg/dL (2.6 mmol/L), medical nutrition therapy is recommended as the first line of treatment to reach the desired goal (LDL-C <100 mg/dL). Medical nutrition therapy includes the following: decreasing saturated fat (<7% total calories), avoiding trans fatty acids, decreasing total cholesterol to <200 mg daily, increasing soluble fiber, and adding phytosterols daily. Results The patient discussed in this case presentation achieved a desired LDL-C level <100 mg/dL (2.6 mmol/L) by following the recommended heart-healthy guidelines. Statin therapy was not considered unless the LDL-C goal, <130 mg/dL (3.38 mmol/L), was not achieved by diet alone. Conclusions In this case study, evidence-based nutrition guidelines have been evaluated and reviewed to demonstrate heart-healthy eating for children with hyperlipidemia and type 1 diabetes. It is known that approximately 40% to 50% of children with elevated lipids will continue to have abnormal lipids into adolescence and early adulthood. Therefore, early screening is recommended by the AHA to track lipid changes during childhood and adolescence and to begin treating abnormal LDL-C levels to prevent the development of atherosclerosis.

 

Diabetes Res Clin Pract. 2009 Feb 23.
The effect of plant sterols or stanols on lipid parameters in patients with type 2 diabetes: A meta-analysis.
Baker WL, Baker EL, Coleman CI.
The Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, United States.
We performed a meta-analysis of five randomized, placebo-controlled trials to characterize the impact of plant sterols/stanols on plasma lipids in patients with type 2 diabetes. Upon meta-analysis, plant sterols/stanols significantly reduced total and LDL cholesterol, with a trend towards improvement in HDL. No beneficial effect on triglycerides was apparent.

Meets Learning Need Codes 5000, 5160, 9000, and 9020
The Evidence for Dietary Prevention and Treatment of Cardiovascular Disease
LINDA VAN HORN, PhD, RD; MIKELLE MCCOIN, MPH, RD; PENNY M. KRIS-ETHERTON, PhD, RD; FRANCES BURKE, MS, RD;
JO ANN S. CARSON, PhD, RD; CATHERINE M. CHAMPAGNE, PhD, RD; WAHIDA KARMALLY, DrPH, RD; GEETA SIKAND, MA, RD- Journal of the AMERICAN DIETETIC ASSOCIATION

Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systematic review and meta-regression analysis. BMJ 2009; 338;B92

Editorials: HDL cholesterol and cardiovascular risk. BMJ 2009;338:a3065
Editorials: HDL cholesterol and cardiovascular risk. BMJ 2009;338:a3065

Curr Opin Clin Nutr Metab Care. 2009 Mar;12(2):147-51.

Phytosterols as functional food ingredients: linkages to cardiovascular disease and cancer.
Jones PJ, AbuMweis SS.
Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Smartpark, Winnipeg, Manitoba, Canada. peter_jones@umanitoba.ca
PURPOSE OF REVIEW: To examine experimental evidence that has examined association of phytosterols and the reduction of the risk of cardiovascular disease and cancer. RECENT FINDINGS: Phytosterols exist as naturally occurring plant sterols that are present in the nonsaponifiable fraction of plant oils. Phytosterols are plant components that have a chemical structure similar to cholesterol except for the addition of an extra methyl or ethyl group; however, phytosterol absorption in humans is considerably less than that of cholesterol. In fact, phytosterols reduce cholesterol absorption, although the exact mechanism is not known, and thus reduce circulating levels of cholesterol. The efficacy of phytosterols as cholesterol-lowering agents have been shown when incorporated into fat spreads as well as other food matrices. In addition, phytosterols have been combined with other beneficial dietary components including fish and olive oils, psyllium and beta-glucan to enhance their effect on risk factors of cardiovascular disease. Phytosterols appear not only to play an important role in the regulation of cardiovascular disease but also to exhibit anticancer properties. A side effect associated with the consumption of phytosterols is that they reduce the blood levels of carotenoid. Nevertheless, it has been suggested that compensation for this impact on serum carotenoid levels can occur either by increasing the intake of carotenoid-rich foods or by taking supplements containing these carotenoids.
SUMMARY: Dietary phytosterols appear to play an important role in the regulation of serum cholesterol and to exhibit anticancer properties.

Curr Pharm Des. 2009;15(5):490-516. 
Lipid-lowering drugs acting at the level of the gastrointestinal tract.
Filippatos TD, Mikhailidis DP.
Department of Clinical Biochemistry, Vascular Disease Prevention Clinics, Royal Free Hospital campus, University College London, London, UK.
This review considers the hypolipidaemic drugs that act on the gastrointestinal (GI) tract. We searched PubMed up to April 2008 and included randomized controlled trials, original papers, review articles and case reports. Bile acid sequestrants (BAS) have a well-established low density lipoprotein cholesterol (LDL-C) lowering effect, but may increase triglyceride (TG) levels. BAS have no systematic adverse effects, but are associated with increased GI adverse effects and interactions with the absorption of other drugs. Ezetimibe improves LDL-C, high density lipoprotein cholesterol and TG levels, as monotherapy or especially when given with a statin. Ezetimibe has not been associated with serious adverse effects. Ezetimibe has not been evaluated in large clinical trials with cardiovascular disease (CVD) endpoints. Phytosterols are not licensed drugs; they have a well-established LDL-C lowering effect, but there are no large long-term randomized clinical trials investigating their effects on CVD events. Orlistat is an antiobesity drug with a small additional LDL-C lowering effect independent of weight loss. Orlistat-assisted weight loss improves the overall lipid profile, carbohydrate metabolism and transaminase activities. However, its use should be limited to weight reduction. This drug is associated with increased GI adverse effects.

J Nutr. 2009 Feb;139(2):271-84. Epub 2008 Dec 17.
Continuous dose-response relationship of the LDL-cholesterol-lowering effect of phytosterol intake.
Demonty I, Ras RT, van der Knaap HC, Duchateau GS, Meijer L, Zock PL, Geleijnse JM, Trautwein EA.
Unilever R&D, 3130 AC Vlaardingen, The Netherlands. isabelle.demonty@unilever.com
Phytosterols (plant sterols and stanols) are well known for their LDL-cholesterol (LDL-C)-lowering effect. A meta-analysis of randomized controlled trials in adults was performed to establish a continuous dose-response relationship that would allow predicting the LDL-C-lowering efficacy of different phytosterol doses. Eighty-four trials including 141 trial arms were included. A nonlinear equation comprising 2 parameters (the maximal LDL-C lowering and an incremental dose step) was used to describe the dose-response curve. The overall pooled absolute (mmol/L) and relative (%) LDL-C-lowering effects of phytosterols were also assessed with a random effects model. The pooled LDL-C reduction was 0.34 mmol/L (95% CI: -0.36, -0.31) or 8.8% (95% CI: -9.4, -8.3) for a mean daily dose of 2.15 g phytosterols. The impacts of subject baseline characteristics, food formats, type of phytosterols, and study quality on the continuous dose-response curve were determined by regression or subgroup analyses. Higher baseline LDL-C concentrations resulted in greater absolute LDL-C reductions. No significant differences were found between dose-response curves established for plant sterols vs. stanols, fat-based vs. non fat-based food formats and dairy vs. nondairy foods. A larger effect was observed with solid foods than with liquid foods only at high phytosterol doses (>2 g/d). There was a strong tendency (P = 0.054) towards a slightly lower efficacy of single vs. multiple daily intakes of phytosterols. In conclusion, the dose-dependent LDL-C-lowering efficacy of phytosterols incorporated in various food formats was confirmed and equations of the continuous relationship were established to predict the effect of a given phytosterol dose. Further investigations are warranted to investigate the impact of solid vs. liquid food formats and frequency of intake on phytosterol efficacy.

 

Lipids. 2009 Jan 15.
Phytosterol Intake and Dietary Fat Reduction are Independent and Additive in their Ability to Reduce Plasma LDL Cholesterol.
Chen SC, Judd JT, Kramer M, Meijer GW, Clevidence BA, Baer DJ.
Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, USDA, ARS, Beltsville, MD, USA.
We studied the interrelationship of diet and plant sterols (PS) on plasma lipids, lipoproteins and carotenoids. Mildly hypercholesterolemic men (n = 13) and postmenopausal women (n = 9) underwent four randomized, crossover, double-blind, controlled feeding periods of 23 days each. The design consisted of two levels of PS (0 and 3.3 g/day) and two background diets having fat content either typical of the American diet (total and saturated fat at 33.5 and 13.2% of energy, respectively), or a Step 1 type of diet (total and saturated fat at 26.4 and 7.7% of energy, respectively). Plasma total cholesterol (TC), high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, Apo A1 and Apo B were 4.3, 5.3, 4.5, 2.8 and 2.5% lower, respectively (P </= 0.0001; <0.0001, 0.0016, 0.0006, and 0.0069), with the Step 1 diet than with the typical American diet. Diet had no effect on TC/HDL cholesterol (P = 0.1062). Plant sterol intake lowered TC, LDL cholesterol, and Apo B by 9.0, 12.4 and 6.1% and TC/HDLC by 9.6% (P </= 0.0001 for all), respectively, without affecting HDL cholesterol and Apo A1 (P = 0.2831 and 0.732). The PS effect in lowering plasma TC and LDL cholesterol was independent of and additive to the effect due to dietary fat reduction. Responses of plasma carotenoids to PS intake were consistent with the literature.

 

Curr Atheroscler Rep. 2008 Dec;10(6):467-72.
Cholesterol-lowering effect of plant sterols.
AbuMweis SS, Jones PJ.
Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Smartpark, 196 Innovation Drive, Winnipeg, Manitoba, R3T 6C5, Canada.
Plant sterols are plant components that have a chemical structure similar to cholesterol except for the addition of an extra methyl or ethyl group; however, plant sterol absorption in humans is considerably less than that of cholesterol. In fact, plant sterols reduce cholesterol absorption and thus reduce circulating levels of cholesterol. Earlier studies that have tested the efficacy of plant sterols as cholesterol-lowering agents incorporated plant sterols into fat spreads. Later on, plant sterols were added to other food matrices, including juices, nonfat beverages, milk and yogurt, cheese, meat, croissants and muffins, and cereal and chocolate bars. The beneficial physiologic effects of plant sterols could be further enhanced by combining them with other beneficial substances, such as olive and fish oils, fibers, and soy proteins, or with exercise. The addition of plant sterols to the diet is suggested by health experts as a safe and effective way to reduce the risk of coronary heart disease.

 

Br J Nutr. 2008 Nov;100(5):937-41
Effects of long-term plant sterol or stanol ester consumption on lipid and lipoprotein metabolism in subjects on statin treatment. (Anche sicurezza)
de Jong A, Plat J, Lütjohann D, Mensink RP.
Department of Human Biology, Maastricht University, Maastricht, The Netherlands.
Consumption of plant sterol- or stanol-enriched margarines by statin users results in an additional LDL-cholesterol reduction of approximately 10 %, which may be larger than the average decrease of 3-7 % achieved by doubling the statin dose. However, whether this effect persists in the long term is not known. Therefore, we examined in patients already on stable statin treatment the effects of 85 weeks of plant sterol and stanol ester consumption on the serum lipoprotein profile, cholesterol metabolism, and bile acid synthesis. For this, a double-blind randomised trial was designed in which fifty-four patients consumed a control margarine with no added plant sterols or stanols for 5 weeks (run-in period). For the next 85 weeks, seventeen subjects continued with the control margarine and the other two groups with either a plant sterol (n 18) or plant stanol (n 19) (2.5 g/d each) ester-enriched margarine. Blood was sampled at the end of the run-in period and every 20 weeks during the intervention period. Compared with the control group, plant sterol and stanol ester consumption reduced LDL-cholesterol by 0.28 mmol/l (or 8.7 %; P = 0.08) and 0.42 mmol/l (13.1 %; P = 0.006) respectively after 85 weeks. No effects were found on plasma concentrations of oxysterols or 7 alpha-hydroxy-4-cholesten-3-one, a bile acid synthesis marker. We conclude that long-term consumption of both plant sterol and stanol esters effectively lowered LDL-cholesterol concentrations in statin users.

 

Nutr Clin Pract. 2008 Oct-Nov;23(5):468-76
Nutrition protocols for the prevention of cardiovascular disease. Retelny VS, Neuendorf A, Roth JL.
Northwestern Memorial Hospital, Wellness Institute, 150 E. Huron, Suite 1100, Chicago, IL 60610, USA.
Cardiovascular disease is the number one cause of death in the United States, and prevention of cardiovascular disease is at the top of the public health agenda. Evidence shows that reducing the incidence of coronary heart disease with diet is possible. More than a half century of evidence from epidemiologic, experimental, and clinical trials pinpoints a positive correlation between lifestyle and dietary factors as they relate to blood lipids, blood pressure, and coronary heart disease risk, and a number of evidence-based nutrition guidelines have emerged. The National Cholesterol Education Program's Therapeutic Lifestyle Changes diet includes unsaturated fats, fiber, and plant sterols/stanols. The whole foods approach incorporates increased consumption of fruits, vegetables, whole grains, and fish; and the American Heart Association guidelines emphasize functional foods like soy protein, nuts, and alcohol. These guidelines display the rationale for nutrition intervention as a primary prevention for cardiovascular disease. In addition, body weight, body mass index, waist circumference, and waist-to-hip ratio are examined as risk factors for cardiovascular disease. This article highlights key nutrients and lifestyle factors in preventing cardiovascular disease and identifies practical applications for clinicians.

 

J Am Coll Nutr. 2008 Oct;27(5):588-95.
Cholesterol-lowering efficacy of plant sterols in low-fat yogurt consumed as a snack or with a meal.
Rudkowska I, AbuMweis SS, Nicolle C, Jones PJ.
School of Dietetics and Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada.
OBJECTIVE: Plant sterols (PS) consumed as a snack may not have the same cholesterol-lowering potential as when consumed with a meal due to poor solubilization. It was hypothesized that the consumption of a single dose, low-fat yogurt rich in PS (1.6 g/d) with a meal over an afternoon snack will lead to favourable changes in plasma lipids, plasma PS concentrations, and cholesterol synthesis without negatively affecting alpha-tocopherol or carotenoids levels. METHODS: Twenty-six hyperlipidemic males and females completed the randomized trial of three phases (control, single PS dose consumed with a meal, or single PS dose as an afternoon snack) while consuming controlled, low-fat diets. Plasma lipids, cholesterol synthesis rates, plasma PS and serum fat-soluble antioxidants were measured at baseline and after 4 weeks. RESULTS: Endpoint total cholesterol (TC) levels after the PS snack phase were decreased (p = 0.04) (5.30 +/- 0.2 mmol/L) compared to the control phase (5.53 +/- 0.2 mmol/L). However, endpoints for TC (5.37 +/- 0.2 mmol/L) for PS dose with a meal were comparable to control phase. Low-density lipoprotein-cholesterol tended to be different (p = 0.06) at the end of the intervention phases (3.51 +/- 0.1, 3.43 +/- 0.1, and 3.33 +/- 0.1 mmol/L; control, meal and snack, respectively). Cholesterol fractional synthesis rates were higher (p = 0.007) by 25.8% and 19.5% at the end of the snack and meal phases, respectively, compared with the control phase. Plasma campesterol and beta-sitosterol concentrations, adjusted for TC, were higher (p < 0.01) in the snack phase (2.30 +/- 0.3 and 0.54 +/- 0.1 micromol/mmol, respectively) and in the meal phase (2.00 +/- 0.3 and 0.51 +/- 0.1 micromol/mmol, respectively) when compared to the control phase (1.81 +/- 0.3 and 0.40 +/- 0.1 micromol/mmol, respectively). No changes in alpha-tocopherol or carotenoids levels were detected after adjusting for TC, for all phases. CONCLUSION: These results indicate that a single dose of PS in low-fat yogurt, provided as a snack, lowers cholesterol levels but does not alter fat-soluble vitamin or carotenoid concentrations in hyperlipidemic participants.

 

Lipids Health Dis. 2008 Oct 6;7(1):35.
Cholesterol lowering effect of a soy drink enriched with plant sterols in a French population with moderate hypercholesterolemia.
Weidner C, Krempf M, Bard JM, Cazaubiel M, Bell D.
ABSTRACT: BACKGROUND: Plant sterols are an established non-pharmacological means to reduce total and LDL blood cholesterol concentrations and are therefore recommended for cholesterol management by worldwide-renown health care institutions. Their efficacy has been proven in many types of foods with the majority of trials conducted in spreads or dairy products. As an alternative to dairy products, soy based foods are common throughout the world. Yet, there is little evidence supporting the efficacy of plant sterols in soy-based foods. The objective of this study was to investigate the effect of a soy drink enriched with plant sterols on blood lipid profiles in moderately hypercholesterolemic subjects. METHODS: In a randomized, placebo-controlled double-blind mono-centric study, 50 subjects were assigned to 200 ml of soy drink either enriched with 2.6 g plant sterol esters (1.6 g/d free plant sterol equivalents) or without plant sterols (control) for 8 weeks. Subjects were instructed to maintain stable diet pattern and physical activity. Plasma concentrations of lipids were measured at initial visit, after 4 weeks and after 8 weeks. The primary measurement was the change in LDL cholesterol (LDL-C). Secondary measurements were changes in total cholesterol (TC), non-HDL cholesterol (non-HDL-C), HDL cholesterol (HDL-C) and triglycerides. RESULTS: Regular consumption of the soy drink enriched with plant sterols for 8 weeks significantly reduced LDL- C by 0.29 mmol/l or 7% compared to baseline (p<0.05). TC and non-HDL-C concentrations decreased by 0.26 mmol/l and 0.31 mmol/l (each p<0.05), respectively. Mean reductions in total, LDL and non-HDL cholesterol were significantly greater than in the placebo group (p<0.05). HDL-C and triglycerides were not affected. Compliance was very high (>96%), and products were well tolerated. CONCLUSION: Daily consumption of a plant sterol-enriched soy drink significantly decreased total, non-HDL and LDL cholesterol and is therefore an interesting and convenient aid in managing mild to moderate hypercholesterolemia.

 

J R Soc Health. 2008 Sep;128(5):248-54.
Targeted versus global approaches to the management of hypercholesterolaemia.
Reynolds TM, Mardani A, Twomey PJ, Wierzbickid AS.
Clinical Chemistry Dept, Queen's Hospital, Belvedere Road, Burton-on-Trent, Staffordshire DE13 0RB, UK., tim.reynolds@burtonh-tr.wmids.nhs.uk
AIMS: The role of statins in secondary prevention of cardiovascular disease is well established. However, there is debate about the most effective approach to primary prevention. This study simulated the effects of directed versus global approaches for intervention on coronary heart disease (CHD) event rates. METHODS: A primary prevention population was generated by computer simulation derived from data from the National Health Survey for England. The efficacy of reductions in cholesterol, treatment to cardiovascular risk targets and effects of phytosterols or statins were assessed. RESULTS: A 0.5 mmol/L reduction in population total cholesterol would result in a 10.4% reduction in CHD events, while 1.0 mmol/L, 1.5 mmol/L and 2.0 mmol/L reductions would achieve 21.0%, 30.6% and 41.9% reductions respectively. In statin-based cardiovascular risk targeted strategies, use of simvastatin 40 mg would result in 1.8% reduction by UK National Service Framework targets of 30%/decade CHD risk and 7.2% reduction in events for a 20%/decade target assuming perfect adherence. Similarly, aggressive primary prevention with 40 mg atorvastatin would result in a 2.5% or 10% reduction in events. Universal use of 10 mg simvastatin following an over-the-counter approach would result in a 25% reduction in CHD events. In contrast, whole population consumption of sitostanol/sitosterol products would result in 11.8% reduction. CONCLUSION: Targeting and treating high-risk individuals may be beneficial for them and rewarding for medical practitioners. However, this approach has minimal effects on the population burden of atherosclerotic disease. This study suggests that universal therapy with phytosterols and/or wider availability of statins has the potential to dramatically decrease rates of CHD.

 

J Lipid Res. 2008 Sep 3. (Anche sicurezza)
The relationships of cholesterol metabolism and plasma plant sterols with the severity of coronary artery disease.
Silbernagel G, Fauler G, Renner W, Landl EM, Hoffmann MM, Winkelmann BR, Boehm BO, März W.
Changes in the balance of cholesterol absorption and synthesis and moderately elevated plasma plant sterols have been suggested to be atherogenic. Measuring cholestanol, lathosterol, campesterol, and sitosterol we investigated the relationships of cholesterol metabolism and plasma plant sterols with the severity of coronary artery disease (CAD) in 2440 participants of the LUdwigshafen RIsk and Cardiovascular health (LURIC) study. The coronary status was determined by angiography and the severity of CAD was assessed by the Friesinger Score (FS). An increase in the ratio of cholestanol to cholesterol was associated with high FS (p = 0.006). In contrast, a high ratio of lathosterol to cholesterol went in parallel with low FS (p < 0.001). Whereas the campesterol to cholesterol ratio significantly correlated with the FS (p = 0.026) the relationship of the sitosterol to cholesterol ratio with the FS did not reach statistical significance in the whole group. Increased campesterol, sitosterol, and cholestanol to lathosterol ratios were associated high FS (p < 0.001). To conclude, there is a modest association of high cholesterol absorption and low cholesterol synthesis with an increased severity of CAD. An atherogenic role of plasma plant sterols themselves, however, seems unlikely in subjects without sitosterolaemia.

 

Nutr Metab Cardiovasc Dis. 2008 Aug 30. (Anche sicurezza)
Effects of a phytosterol-enriched dairy product on lipids, sterols and 8-isoprostane in hypercholesterolemic patients: A multicenter Italian study.
Mannarino E, Pirro M, Cortese C, Lupattelli G, Siepi D, Mezzetti A, Bertolini S, Parillo M, Fellin R, Pujia A, Averna M, Nicolle C, Notarbartolo A.
Medicina Interna, Angiologia e Malattie da Arteriosclerosi, Università di Perugia, Perugia, Italy.
BACKGROUND AND AIMS: Plant sterols, added to several food sources, lower serum cholesterol concentrations. Plant sterol-induced cholesterol lowering is paralleled by a mild decrease in plasma levels of the antioxidant beta-carotene, the amount of this decrease being considered clinically non-significant. Whether the effect on lipid profile of daily consumption of plant sterol-enriched low-fat fermented milk (FM) is paralleled by a concomitant variation in a reliable marker of the oxidative burden like plasma isoprostane levels is unresolved. METHODS AND RESULTS: The effect of plant sterol consumption on plasma lipid and isoprostane levels of hypercholesterolemic patients was evaluated in a multicenter, randomized double blind study. Hypercholesterolemic patients consumed a FM daily for 6weeks. Subjects were randomized to receive either 1.6g of plant sterol-enriched FM (n=60) or control FM product (n=56). After 6weeks of plant sterol-enriched FM consumption, LDL cholesterol was reduced from 166.2+/-2.0 to 147.4+/-2.8mg/dL (p=0.01). A significant reduction was observed for total cholesterol (from 263.5+/-2.6 to 231.0+/-3.2mg/dL, p=0.01). There was greater LDL cholesterol lowering among hypercholesterolemic patients with higher LDL cholesterol at baseline. We found a reduction of plasma 8-isoprostane in patients taking plant sterol-enriched FM (from 43.07+/-1.78 to 38.04+/-1.14pg/ml, p=0.018) but not in patients taking the control product (from 42.56+/-2.12 to 43.19+/-2.0pg/ml, p=NS). Campesterol and beta-sitosterol levels were not influenced by phytosterol consumption. CONCLUSIONS: Daily consumption of low-fat plant sterol dairy product favourably changes lipid profile by reducing LDL-cholesterol, and may also have an anti-oxidative effect through a reduction of plasma isoprostanes.

 

Food Nutr Res. 2008;52. doi: 10.3402/fnr.v52i0.1811. Epub 2008 Aug 18.
Plant sterols/stanols as cholesterol lowering agents: A meta-analysis of randomized controlled trials.
Abumweis SS, Barake R, Jones PJ.
School of Dietetics and Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada (SSA and RB).
BACKGROUND: Consumption of plant sterols has been reported to reduce low density lipoprotein (LDL) cholesterol concentrations by 5-15%. Factors that affect plant sterol efficacy are still to be determined. OBJECTIVES: To more precisely quantify the effect of plant sterol enriched products on LDL cholesterol concentrations than what is reported previously, and to identify and quantify the effects of subjects' characteristics, food carrier, frequency and time of intake on efficacy of plant sterols as cholesterol lowering agents. DESIGN: Fifty-nine eligible randomized clinical trials published from 1992 to 2006 were identified from five databases. Weighted mean effect sizes were calculated for net differences in LDL levels using a random effect model. RESULTS: Plant sterol containing products decreased LDL levels by 0.31 mmol/L (95% CI, -0.35 to -0.27, P= < 0.0001) compared with placebo. Between trial heterogeneity was evident (Chi-square test, P = <0.0001) indicating that the observed differences between trial results were unlikely to have been caused by chance. Reductions in LDL levels were greater in individuals with high baseline LDL levels compared with those with normal to borderline baseline LDL levels. Reductions in LDL were greater when plant sterols were incorporated into fat spreads, mayonnaise and salad dressing, milk and yoghurt comparing with other food products such as croissants and muffins, orange juice, non-fat beverages, cereal bars, and chocolate. Plant sterols consumed as a single morning dose did not have a significant effect on LDL cholesterol levels. CONCLUSION: Plant sterol containing products reduced LDL concentrations but the reduction was related to individuals' baseline LDL levels, food carrier, and frequency and time of intake.

 

J Clin Endocrinol Metab. 2008 Aug 12.
Recognition and Management of Dyslipidemia in Children and Adolescents.
Kwiterovich PO Jr.
Lipid Research Atherosclerosis Division, Departments of Pediatrics and Medicine, The Johns Hopkins Medical Institutions, 550 North Broadway, Suite 310, Baltimore, MD 21205.
Context. Cardiovascular disease (CVD) remains the number one cause of death in the USA. The origins of atherosclerosis and CVD begin in childhood. Dyslipidemia and obesity are endemic in American youth and require urgent action. Evidence Acquisition. A detailed literature search from 1985 to 2008 was performed using PubMed and subsequent reference searches of retrieved articles. Selection of included articles was based on rigor of scientific design, adequate sample size, quality of the data, statistical analysis and hypothesis testing. Evidence Synthesis. CVD risk factors in children predict pathologic lesions of atherosclerosis in young adults, and their clinical manifestations, as judged by carotid intima medial thickness, coronary artery calcium, or brachial flow-mediated dilatation. About half the offspring of a parent with premature CVD have a primary dyslipidemia. However, use of family history to identify such youth will miss the majority of children with dyslipidemia. Treatment of dyslipidemia starts with a low fat diet supplemented with water-soluble fiber, plant stanols and plant sterols, weight control and exercise. Drug therapy with inhibitors of hydroxymethylglutaryl CoA reductase, bile acid sequestrants, and cholesterol absorption inhibitors, can be considered in adolescents with a positive family history of premature CVD and a LDL-C > 160 mg/dL. Such dietary and drug therapy appears safe and efficacious and is likely to retard atherosclerosis. Conclusions. Early identification and treatment of youth at risk for early atherosclerosis will require an integrated assessment of predisposing CVD risk factors and a comprehensive universal screening and treatment program.

 

Atherosclerosis. 2008 Jul 6.
New insights into the molecular actions of plant sterols and stanols in cholesterol metabolism.
Calpe-Berdiel L, Escolà-Gil JC, Blanco-Vaca F.Servei de Bioquímica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona. Spain.
Plant sterols and stanols (phytosterols/phytostanols) are known to reduce serum low-density lipoprotein (LDL)-cholesterol level, and food products containing these plant compounds are widely used as a therapeutic dietary option to reduce plasma cholesterol and atherosclerotic risk. The cholesterol-lowering action of phytosterols/phytostanols is thought to occur, at least in part, through competition with dietary and biliary cholesterol for intestinal absorption in mixed micelles. However, recent evidence suggests that phytosterols/phytostanols may regulate proteins implicated in cholesterol metabolism both in enterocytes and hepatocytes. Important advances in the understanding of intestinal sterol absorption have provided potential molecular targets of phytosterols. An increased activity of ATP-binding cassette transporter A1 (ABCA1) and ABCG5/G8 heterodimer has been proposed as a mechanism underlying the hypocholesterolaemic effect of phytosterols. Conclusive studies using ABCA1 and ABCG5/G8-deficient mice have demonstrated that the phytosterol-mediated inhibition of intestinal cholesterol absorption is independent of these ATP-binding cassette (ABC) transporters. Other reports have proposed a phytosterol/phytostanol action on cholesterol esterification and lipoprotein assembly, cholesterol synthesis and apolipoprotein (apo) B100-containing lipoprotein removal. The accumulation of phytosterols in ABCG5/G8-deficient mice, which develop features of human sitosterolaemia, disrupts cholesterol homeostasis by affecting sterol regulatory element-binding protein (SREBP)-2 processing and liver X receptor (LXR) regulatory pathways. This article reviews the progress to date in studying these effects of phytosterols/phytostanols and the molecular mechanisms involved.

 

Atherosclerosis. 2008 Jun 26. (Anche sicurezza)
Association of plasma phytosterol concentrations with incident coronary heart disease Data from the CORA study, a case-control study of coronary artery disease in women.
Windler E, Zyriax BC, Kuipers F, Linseisen J, Boeing H.
Division of Endocrinology and Metabolism of Ageing, University Hospital Hamburg-Eppendorf, Germany.
AIMS: Phytosterols have been proposed to be atherogenic. This research investigates whether plasma concentrations of phytosterols correlate with the manifestation of coronary heart disease. METHODS AND RESULTS: The CORA study compares clinical, biochemical, and lifestyle factors in consecutive pre- and postmenopausal women with incident coronary heart disease to those in age-matched population-based controls. Controls (n=231) had significantly higher plasma concentrations of the major phytosterol species than cases (n=186) (4.649mg/l vs. 4.092mg/l; p<0.001). Cases had a higher dietary intake of phytosterols, but the ratio of lathosterol over sitosterol did not significantly differ. Phytosterols correlated with cholesterol concentrations of LDL and HDL, the phytosterol-carrying lipoproteins. The age-adjusted odds ratio for the association of total phytosterols and risk of coronary heart disease was 0.69 per 5mg/dl (95% CI 0.46-0.99). After adjustment for LDL- and HDL-cholesterol the odds ratio approached 1 (0.89; 95% CI 0.61-1.30), which was reached after additional adjustment for major risk factors, particularly those reflecting the metabolic syndrome (1.05; 95% CI 0.64-1.97). CONCLUSIONS: Healthy controls had higher unadjusted concentrations of plasma phytosterols, but the adjusted odds ratio for coronary heart disease did not point to an impact of plasma phytosterols on coronary heart disease.

Nutr Res. 2008 Apr;28(4):217-25. (Anche sicurezza)
Phytosterols: physiologic and metabolic aspects related to cholesterol-lowering properties.
Brufau G, Canela MA, Rafecas M.
Department of Nutrition and Food Science, CeRTA (Nutrició i Salut), University of Barcelona, 08028 Barcelona, Spain.
The aim of this review is to give a general contemporary overview of the physiologic effects of phytosterols and their role in cholesterol uptake in the intestinal tract. The mechanism of phytosterols action is based on its ability to reduce cholesterol absorption. Doses of 0.8 to 4.0 g/d of phytosterols were used to reduce low-density lipoprotein cholesterol concentrations by 10% to 15%, although most of the studies described used 2 g/d of phytosterol to achieve a reduction of 10% in low-density lipoprotein cholesterol concentrations. Although some studies point to the possibility that elevated plasma phytosterol concentrations could contribute to the development of premature coronary artery diseases, extensive safety evaluation studies have been conducted for these compounds, and they have been considered safe.

 

Metabolism. 2008 Mar;57(3):339-46.
Efficacy of plant sterols is not influenced by dietary cholesterol intake in hypercholesterolemic individuals.
Kassis AN, Vanstone CA, AbuMweis SS, Jones PJ.
School of Dietetics and Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Montréal, Québec, Canada.
Plant sterols (PSs) reduce plasma total and low-density lipoprotein cholesterol (LDL-C) levels by reducing cholesterol absorption; however, it is not known whether the level of dietary cholesterol intake has an impact on the efficacy of PSs on blood lipids. The purpose of this study was to determine the effect of high vs low dietary cholesterol levels on the lipid-lowering efficacy of free PSs. The study was a semirandomized, double-blind, crossover trial consisting of four 28-day feeding phases each separated by a 4-week washout period. Otherwise healthy hypercholesterolemic subjects (n = 22) consumed each of (a) low-cholesterol control (C(-)S(-)), (b) high-cholesterol control (C(+)S(-)), (c) 22 mg PSs per kilogram of body weight with a low-cholesterol diet (C(-)S(+)), and (d) 22 mg PSs per kilogram of body weight with a high-cholesterol diet (C(+)S(+)). Blood was drawn on the first and last 2 days of each phase to measure plasma total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triacylglycerols as well as plasma campesterol and beta-sitosterol concentrations. Dietary cholesterol had no effect on PS efficacy as a cholesterol-lowering agent because no interaction was found between the 2 factors. However, dietary cholesterol and PS intake had significant independent effects on plasma total cholesterol, LDL-C, and high-density lipoprotein cholesterol levels. beta-Sitosterol levels in plasma increased (P < .0001) as a result of PS supplementation. Data from the present study indicate that, although PSs and dietary cholesterol exert independent effects on plasma cholesterol, PS efficacy is not affected by varying levels of cholesterol intake.

 

Eur J Clin Nutr. 2008 Feb 13. (Anche sicurezza)
Safety assessment of common foods enriched with natural nonesterified plant sterols.
Tuomilehto J, Tikkanen MJ, Högström P, Keinänen-Kiukaanniemi S, Piironen V, Toivo J, Salonen JT, Nyyssönen K, Stenman UH, Alfthan H, Karppanen H[1] 1Department of Health Promotion and Chronic Disease Prevention, Division of Biochemistry, National Public Health Institute, University of Helsinki, Finland [2] 2Department of Public Health, University of Helsinki, Finland [3] 3South Ostrobothnia Central Hospital, Seinäjoki, Finland.
Background/Objectives: To assess safety during a diet based on low-fat foods enriched with nonesterified wood-derived plant sterols and mineral nutrients related to serum phytosterol, sex hormone and fat-soluble vitamin metabolism.Subjects/Methods: Seventy-one study participants (52 women, 19 men) with mild-to-moderate hypercholesterolemia completed the double-blind, placebo-controlled feeding trial lasting for 15 weeks. The subjects were randomly allocated to the sterol group receiving food items enriched with mineral nutrients as well as with a total of 1.25, 2.5 and 5.0 g per day of plant sterols during the first, second and third 5-week periods, respectively, or to the placebo group receiving similar food items without plant sterols. This outpatient clinical trial with free-living subjects was carried out at two hospital clinics.Results: Two significant findings were observed. Serum sitosterol concentrations increased from 2.84 to 5.35 mg l(-1) (P<0.004 vs placebo) but those of serum total plant sterols did not because of compensatory changes in other phytosterols. The highest plant sterol levels did not exceed 0.6% of total serum sterols. Serum alpha-tocopherol concentrations decreased in the sterol group by 10% (P<0.0002), but the between-group difference disappeared after adjusting for the change in the carrier (LDL cholesterol).Conclusions: Fifteen-week consumption of natural nonesterified plant sterol-enriched food does not cause any serious adverse effects during such a period. However, serum alpha-tocopherol levels were somewhat reduced in the sterol group suggesting that long-term effects of plant sterols on serum fat-soluble vitamin concentrations should be further explored, especially in relation to very low-fat diets.European Journal of Clinical Nutrition advance online 13 February 2008; doi:10.1038/ejcn.2008.11.

 

Metabolism. 2008 Jan;57(1):130-9
Effect of plant sterols in combination with other cholesterol-lowering foods.
Jenkins DJ, Kendall CW, Nguyen TH, Marchie A, Faulkner DA, Ireland C, Josse AR, Vidgen E, Trautwein EA, Lapsley KG, Holmes C, Josse RG, Leiter LA, Connelly PW, Singer W.
Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada M5C 2T2. cyril.kendall@utoronto.ca
The National Cholesterol Education Program Adult Treatment Panel III guidelines advocate effective combinations of cholesterol-lowering dietary components. This approach (dietary portfolio) produces large reductions in serum cholesterol, but the contribution of individual components remains to be established. We therefore assessed the effect of eliminating one out of the 4 dietary portfolio components. Plant sterols were selected because at 2 g/d, they have been reported to reduce low-density lipoprotein cholesterol (LDL-C) by 9% to 14%. Forty-two hyperlipidemic subjects were prescribed diets high in soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal), and almonds (23 g/1000 kcal) for 80 weeks. Subjects were instructed to take these together with plant sterols (1.0 g/1000 kcal) except between weeks 52 and 62. While taking the full dietary portfolio, including plant sterols, mean LDL-C reduction from baseline was 15.4% +/- 1.6% (P < .001). After sterol elimination, mean LDL-C reduction was 9.0% +/- 1.5% (P < .001). Comparable LDL-C reductions were also seen for the 18 subjects with a complete data set: on plant sterols, 16.7% +/- 3.1% (P < .001) and off plant sterols, 10.3% +/- 2.6% (P < .001), resulting in a 6.3% +/- 2.0% (P = .005) difference attributable to plant sterols. Compliance in this group of 18 was 67.0% +/- 5.9% for plant sterols and 61.9% +/- 4.8% for the other components. In combination with other cholesterol-lowering foods and against the background of a low-saturated fat diet, plant sterols contributed over one third of the LDL-C reduction seen with the dietary portfolio after 1 year of following dietary advice.

 

Sterols play major role in dietary portfolio for hearts.
By Stephen Daniells
Source: Metabolism (Elsevier), January 2008, Volume 57, Issue 1, Pages 130-139
Effect of plant sterols in combination with other cholesterol-lowering foods"
Authors: D.J.A. Jenkins, C.W.C. Kendall, T.H. Nguyen, A. Marchie, D.A. Faulkner, C. Ireland, A.R. Josse, E. Vidgen, E.A. Trautwein, K.G. Lapsley, C. Holmes, R.G. Josse, L.A. Leiter, P.W. Connelly, W. Singer. 
Almost one-third of cholesterol reductions achieved by consuming a heart-healthy diet are due to plant sterols, suggests a new study from Canada that supports the ingredient's efficacy.
Forty-two subjects with high cholesterol levels were assigned to eat a diet high in soy protein, viscous fibres, and almonds for 80 weeks, and supplemented with plant sterols. At the end of the study, significant reductions were observed in LDL cholesterol levels, report the researchers in the journal Metabolism.
High cholesterol levels, hypercholesterolaemia, have a long association with many diseases, particularly cardiovascular disease (CVD), the cause of almost 50 per cent of deaths in Europe, and are reported to cost the EU economy an estimated €169bn ($202bn) per year.
"In the context of a low-saturated fat diet and in combination with other cholesterol-lowering dietary components, plant sterols appear to exert a very significant effect on LDL-C reduction of the order of 10 per cent for two grams per day of plant sterols," wrote lead author David Jenkins from St Michael's Hospital, Toronto.
"This figure is similar to studies where plant sterols have been given as the only cholesterol-lowering agent."
Numerous clinical trials in controlled settings have reported that daily consumption of 1.5 to 3 grams of phytosterols/stanols can reduce total cholesterol levels by eight to 17 per cent, representing a significant reduction in the risk of cardiovascular disease.
The new study, which was partly funded by Unilever and many of the scientists admit ties to the company, adhered to the guidelines set out by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). According to these guidelines, LDL cholesterol reductions of 25 to 35 per cent are estimated.
"However, it is not clear what cholesterol reduction each functional food component contributes to the overall cholesterol reduction observed and whether all ingredients have to be present," explained the researchers.
Jenkins and co-workers prescribed the 42 subjects (average age 63) to a diet containing viscous fibres (10 g/1,000 kcal), soy protein (22.5 g/1,000 kcal), and almonds (23 g/1,000 kcal) for 80 weeks. In addition, plant sterols were taken (one gram per 1,000 kcal), except during weeks 52 to 62.
Over the course of the study, LDL-cholesterol levels decreased by an average of 15.4 per cent, while such reductions were only 9.0 per cent in the absence of plant sterols.
Complete data was only available in 18 subjects, but similar reductions were observed, report the researchers, with a 16.7 per cent decrease overall, and 10.3 per cent in the absence of sterols.
The results showed, state Jenkins and co-workers, that plant sterols contribute over one-third of the LDL-cholesterol reductions observed in combination with other cholesterol-lowering foods.
"Increased plant sterol intakes are likely to have been a part of the ancestral human diet at about one gram per day and are part of a more plant-based diet as currently recommended for CHD risk reduction, including green leafy vegetables, raw or dry roasted nuts, and non-hydrogenated vegetable oils," wrote the researchers.
"Their reintroduction into the Western diet to prevent CHD may be seen as similar to the desire to reintroduce fibre into the diet to reduce the risk of a number of chronic diseases.
"Plant sterols therefore appear a good fit with other cholesterol-lowering components in a dietary portfolio to reduce CHD risk," they concluded.
The researchers were affiliated with St Michael's Hospital (Toronto), the University of Toronto, Unilever R&D Vlaardingen, and the Almond Board of California.

 

Eur J Clin Nutr. 2008 Feb 13
Safety assessment of common foods enriched with natural nonesterified plant sterols.
Tuomilehto J, Tikkanen MJ, Högström P, Keinänen-Kiukaanniemi S, Piironen V, Toivo J, Salonen JT, Nyyssönen K, Stenman UH, Alfthan H, Karppanen H.
[1] 1Department of Health Promotion and Chronic Disease Prevention, Division of Biochemistry, National Public Health Institute, University of Helsinki, Finland [2] 2Department of Public Health, University of Helsinki, Finland [3] 3South Ostrobothnia Central Hospital, Seinäjoki, Finland.
Background/Objectives: To assess safety during a diet based on low-fat foods enriched with nonesterified wood-derived plant sterols and mineral nutrients related to serum phytosterol, sex hormone and fat-soluble vitamin metabolism.Subjects/Methods: Seventy-one study participants (52 women, 19 men) with mild-to-moderate hypercholesterolemia completed the double-blind, placebo-controlled feeding trial lasting for 15 weeks. The subjects were randomly allocated to the sterol group receiving food items enriched with mineral nutrients as well as with a total of 1.25, 2.5 and 5.0 g per day of plant sterols during the first, second and third 5-week periods, respectively, or to the placebo group receiving similar food items without plant sterols. This outpatient clinical trial with free-living subjects was carried out at two hospital clinics.Results: Two significant findings were observed. Serum sitosterol concentrations increased from 2.84 to 5.35 mg l(-1) (P<0.004 vs placebo) but those of serum total plant sterols did not because of compensatory changes in other phytosterols. The highest plant sterol levels did not exceed 0.6% of total serum sterols. Serum alpha-tocopherol concentrations decreased in the sterol group by 10% (P<0.0002), but the between-group difference disappeared after adjusting for the change in the carrier (LDL cholesterol).Conclusions: Fifteen-week consumption of natural nonesterified plant sterol-enriched food does not cause any serious adverse effects during such a period. However, serum alpha-tocopherol levels were somewhat reduced in the sterol group suggesting that long-term effects of plant sterols on serum fat-soluble vitamin concentrations should be further explored, especially in relation to very low-fat diets.

 

Stroke 2008; 39: 329-35
Il colesterolo rischioso per placche carotidee
Nei soggetti asintomatici con ispessimento delle pareti vasali, il livello di colesterolo è fortemente associato alla presenza di un nucleo lipidico nella placca, e pertanto di vulnerabilità alla rottura. La presenza di un nucleo lipidico, composto di depositi tissutali morti adiposi all'interno di una placca arteriosclerotica, pone la placca a rischio di causare un evento clinico negativo come un ictus se la placca si trova nella carotide, o un attacco cardiaco se si trova in una coronaria. Il presente studio suggerisce che il livello di colesterolo sia il più importante fattore di rischio di sviluppo di questa pericolosa caratteristica della placca. Ciò supporta la nozione secondo cui la riduzione del colesterolo prevenga la sua formazione e riduca il rischio di un evento clinico del genere.

 

Circulation 2007;115;1948-1967; originally published online Mar 21, 2007
Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents: A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, With the Council on Cardiovascular Nursing.
Brian W. McCrindle, Elaine M. Urbina, Barbara A. Dennison, Marc S. Jacobson, Julia, Steinberger, Albert P. Rocchini, Laura L. Hayman and Stephen R. Daniels.

 

Stroke 2007; 38: 2646-51
Ipercolesterolemia associata a piccoli ictus
Elevati livelli sierici totali di colesterolo potrebbe favorire lo sviluppo di ictus minori, prevalentemente a carico di piccoli vasi, che hanno una prognosi piuttosto favorevole, piuttosto che di ictus maggiori con prognosi peggiori. In pratica, sussiste una correlazione inversa di tipo quasi lineare fra livelli di colesterolo e gravità degli ictus. L'aumento dei livello di colesterolo è associato anche ad una diminuzione della mortalità. I risultati dello studio supportano l'ipotesi in base alla quale l'ipercolesterolemia sia principalmente associata ad ictus minori dovuti all'occlusione di piccoli vasi.

 

Am J Hypertens 2007; 20: 541-5 e 546-7
Iperglicemia postprandiale danneggia variabilità pressoria diurna.
L'iperglicemia postprandiale è più comune dell'iperglicemia a digiuno nei pazienti con diabete di tipo 2 con mancata diminuzione notturna della pressione. Al momento non è il caso di raccomandare variazioni del trattamento antidiabetico per il ripristino della corretta variabilità pressoria, ma considerando l'importanza dell'iperglicemia postprandiale per gli eventi cardiovascolari, sarebbe opportuno trattare sia l'iperglicemia a digiuno che quella postprandiale in questi pazienti. Il collegamento meccanico fra anomalie della variabilità pressoria notturna e anomalie del metabolismo del glucosio rimane poco chiaro: l'anello mancante potrebbe consistere in una disfunzione autonomica e delle cellule endoteliali.

 

Int J Clin Pract. 2007 Nov;61(11):1812-8.
Effect of combining viscous fibre with lovastatin on serum lipids in normal human subjects.
Agrawal AR, Tandon M, Sharma PL.
Department of Pharmaceutical Medicine, Jamia Hamdard University, Majeedia Hospital, New Delhi, India. ashish.agrawal2@ranbax.com
OBJECTIVES: Soluble fibre supplements are recommended to reduce the levels of low-density lipoprotein cholesterol (LDL-C). Limited information exists on the interaction between fibre and hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). The purpose of the present study was to evaluate the per se effect of psyllium (10 g/day) and lovastatin (20 mg/day) alone and in combination on serum lipids in normal human volunteers. METHODS: In a 4-week open label, randomised, parallel study, subjects were randomised to receive 20 mg of lovastatin, 10 g of psyllium or 20 mg of lovastatin plus 10 g of psyllium in evening daily. Levels of total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol (HDL-C), TC/LDL-C ratio, LDL-C/HDL-C ratio and triglycerides were determined after 1, 2, 3 and 4 weeks of treatment. RESULTS: The study group comprised 36 adult, male subjects. All treatments were well tolerated, and after 4 weeks the mean LDL-C, TC and TG levels in the group receiving 20 mg of lovastatin plus 10 g of psyllium fell by 30.88%, 26.88% and 26.21% from baseline, compared with 24.78%, 19.55% and 32.88% in the group receiving 20 mg of lovastatin and 3.58%, 2.90% and 10.95% in the group receiving 10 g of psyllium respectively. Although additive effect was observed in the group receiving combination compared with group receiving lovastatin, the observed difference was not statistically significant. No significant changes from baseline in HDL-C levels occurred. CONCLUSIONS: Psyllium soluble fibre should be considered as a safe and well-tolerated dietary supplement option to enhance cholesterol lowering.

 

Br J Nutr. 2007 Jul 30;:1-8
Comparison of a dietary portfolio diet of cholesterol-lowering foods and a statin on LDL particle size phenotype in hypercholesterolaemic participants.
Gigleux I, Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de Souza R, Emam A, Parker TL, Trautwein EA, Lapsley KG, Connelly PW, Lamarche B.
Institute of Nutraceuticals and Functional Foods, Laval University, Quebec, Canada.
The effect of diet v. statins on LDL particle size as a risk factor for CVD has not been examined. We compared, in the same subjects, the impact of a dietary portfolio of cholesterol-lowering foods and a statin on LDL size electrophoretic characteristics. Thirty-four hyperlipidaemic subjects completed three 1-month treatments as outpatients in random order: a very-low saturated fat diet (control); the same diet with 20 mg lovastatin; a dietary portfolio high in plant sterols (1 g/4200 kJ), soya proteins (21.4 g/4200 kJ), soluble fibres (9.8 g/4200 kJ) and almonds (14 g/4200 kJ). LDL electrophoretic characteristics were measured by non-denaturing polyacrylamide gradient gel electrophoresis of fasting plasma at 0, 2 and 4 weeks of each treatment. The reductions in plasma LDL-cholesterol levels with the dietary portfolio and with statins were comparable and were largely attributable to reductions in the estimated concentration of cholesterol within the smallest subclass of LDL (portfolio - 0.69 (se 0.10) mmol/l, statin - 0.99 (se 0.10) mmol/l). These were significantly greater (P < 0.01) than changes observed after the control diet ( - 0.17 (se 0.08) mmol/l). Finally, baseline C-reactive protein levels were a significant predictor of the LDL size responsiveness to the dietary portfolio but not to the other treatments. The dietary portfolio, like the statin treatment, had only minor effects on several features of the LDL size phenotype, but the pronounced reduction in cholesterol levels within the small LDL fraction may provide additional cardiovascular benefit over the traditional low-fat diet of National Cholesterol Education Program Step II.

 

Eur J Clin Nutr. 2007 Apr 25;
Long-term effects of a plant-based dietary portfolio of cholesterol-lowering foods on blood pressure.
Jenkins DJ, Kendall CW, Faulkner DA, Kemp T, Marchie A, Nguyen TH, Wong JM, de Souza R, Emam A, Vidgen E, Trautwein EA, Lapsley KG, Josse RG, Leiter LA, Singer W.
[1] 1Clinical Nutrition &#38; Risk Factor Modification Center, St Michael's Hospital, Toronto, ON, Canada [2] 2Department of Medicine, Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada [3] 3Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada [4] 4Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Objective:To determine the effect on blood pressure of dietary advice to consume a combination of plant-based cholesterol-lowering foods (dietary portfolio).Methods:For 1 year, 66 hyperlipidemic subjects were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal) and almonds (22.5 g/1000 kcal). There was no control group. Seven-day diet record, blood pressure and body weight were monitored initially monthly and later at 2-monthly intervals throughout the study.Results:Fifty subjects completed the 1-year study. When the last observation was carried forward for non-completers (n=9) or those who changed their blood pressure medications (n=7), a small mean reduction was seen in body weight 0.7+/-0.3 kg (P=0.036). The corresponding reductions from baseline in systolic and diastolic blood pressure at 1 year (n=66 subjects) were -4.2+/-1.3 mm Hg (P=0.002) and -2.3+/-0.7 mm Hg (P=0.001), respectively. Blood pressure reductions occurred within the first 2 weeks, with stable blood pressures 6 weeks before and 4 weeks after starting the diet. Diastolic blood pressure reduction was significantly related to weight change (r=0.30, n=50, P=0.036). Only compliance with almond intake advice related to blood pressure reduction (systolic: r=-0.34, n=50, P=0.017; diastolic: r=-0.29, n=50, P=0.041).Conclusions:A dietary portfolio of plant-based cholesterol-lowering foods reduced blood pressure significantly, related to almond intake. The dietary portfolio approach of combining a range of cholesterol-lowering plant foods may benefit cardiovascular disease risk both by reducing serum lipids and also blood pressure.European Journal of Clinical Nutrition advance online publication, 25 April 2007; doi:10.1038/sj.ejcn.1602768.

 

Rocz Panstw Zakl Hig. 2007;58(1):47-51.
The mechanisms of blood LDL-cholesterol lowering by phytosterols--a review
Włodarek D.
Katedra Dietetyki, Szkoła Główna Gospodarstwa Wiejskiego w Warszawie, 02-776 Warszawa. dariusz_wlodarek@sggw.pl
Daily cholesterol consumption in western countries reaches as much as 400 mg. According to the health recommendations the daily intake should not exceed 300 mg and in the case of people with cardiovascular disease it should be less than 200 mg. For 50 years it is known that phytosterols can decrease the level of cholesterol in blood. One of the mechanisms is based on the fact that phytosterols stop absorption of cholesterol in digestive tract, which results in the decrease of the concentration of cholesterol in blood. The second mechanism is based on the fact that cholesterol is pumped back out of enterocytes into the lumen of small intestine by ABC transporter and phytosterols increase this process. The above merftioned mechanisms are different than the way statins can lower cholesterol level and they are commonly used as hipocholesterolemic medicine. Because different mechanisms are implemented both statins and fitosterols can be used in therapy of hipercholeserolemia. The people taking statins who still have increased level of total cholesterol and LDL-cholesterol in blood can include phytosterols in their diet what can lead to the decrease of its level.

 

The Journal of Nutrition Nutrient Physiology, Metabolism, and Nutrient-Nutrient Interactions
J Nutr. 2006 Oct;136(10):2492-7.
A Combination Therapy Including Psyllium and Plant Sterols Lowers LDL Cholesterol by Modifying Lipoprotein Metabolism in Hypercholesterolemic Individuals.
Sudeep Shrestha,2 Jeff S. Volek,3 Jay Udani,4 Richard J.Wood,2 Christine M. Greene,2 Dimple Aggarwal,2 John H. Contois,5 Ben Kavoussi,4 and Maria Luz Fernandez2* 2Department of Nutritional Sciences and 3Department of Kinesiology, University of Connecticut, Storrs, CT 06269; 4Medicus Research LLC, Northdrige, CA 91325; and 5Liposcience Inc., Raleigh, NC 27616.
We conducted a randomized, double blind, crossover, placebo-controlled study to determine the effects of a combination therapy including plant sterols (PS) and psyllium (PSY), provided via cookies, on plasma lipids and on the size and subfraction distribution of VLDL, LDL, and HDL. Thirty-three healthy free-living individuals (11 males and 22 females), aged 35-65 y, with a BMI between 25 and 35 kg/m(2) and initial plasma LDL cholesterol (LDL-C) concentrations between 2.6 and 4.1 mmol/L (100 and 160 mg/dL), were randomly assigned to receive treatment cookies (7.68 g/d PSY and 2.6 g/d PS) or placebo cookies (0 g PSY+PS) for 4 wk. After a 3-wk washout period, subjects received the other cookies for an additional 4 wk. Plasma total cholesterol concentrations were significantly reduced for all subjects, from 5.65 +/- 0.72 mmol/L after the placebo period to 5.28 +/- 0.76 mmol/L after the PSY+PS cookie period (P < 0.01). These reductions were primarily in LDL-C, which decreased from 3.48 +/- 0.70 to 3.14 +/- 0.78 mmol/L after PSY+PS cookie consumption (P < 0.01). Intake of the PSY+PS cookie decreased the number of intermediate density lipoprotein (IDL), LDL, and HDL particles (P < 0.05) and plasma apo B concentrations (P < 0.01). The decreases in LDL and HDL particles were in the small subfractions. Because smaller LDL particles are associated with an increased risk of heart disease and because smaller HDL particles are indicative of diminished reverse cholesterol transport, we conclude that the combination therapy resulted in a less atherogenic lipoprotein profile. In addition, the evaluation of lipoprotein subfractions resulting from the action of the fiber and plant sterols in the intestinal lumen provides an insight on the secondary mechanisms of plasma LDL-C lowering.

The Journal of Nutrition Nutrient Physiology, Metabolism, and Nutrient-Nutrient Interactions
A Combination of Psyllium and Plant Sterols Alters Lipoprotein Metabolism in Hypercholesterolemic Subjects by Modifying the Intravascular Processing of Lipoproteins and Increasing LDL Uptake1,2
Sudeep Shrestha,3 Hedley C. Freake,3 Mary M. McGrane,3 Jeff S. Volek,4 and Maria Luz Fernandez3* Departments of 3Nutritional Sciences and 4Kinesiology, University of Connecticut, Storrs, CT 06269

 

Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

 

Atherosclerosis. 2006 Nov 28
Moderately elevated plant sterol levels are associated with reduced cardiovascular risk-The LASA study.
Fassbender K, Lütjohann D, Dik MG, Bremmer M, König J, Walter S, Liu Y, Letièmbre M, von Bergmann K, Jonker C.
Department of Neurology, University Clinic of the Saarland, Kirrberger Str., D-68421 Homburg, Germany.
Functional foods with supplementation of plant sterols are already used by millions of people. However, at the same time it is current scientific thinking that elevation of plant sterols in the circulation causes coronary heart disease. Therefore, this study aimed to define the risk for coronary heart disease associated with moderately high plant sterol plasma levels in a cohort of elderly. In this study, we evaluated the association between plant sterols and coronary heart disease in a cohort of 1242 subjects older than 65 years, participating at the Longitudinal Aging Study Amsterdam (LASA). Concentrations of sitosterol, campesterol, brassicasterol and stigmasterol were assessed using highly sensitive and specific gas chromatography-mass spectrometry-selected ion-monitoring. Plant sterol concentrations (and their ratios to cholesterol) were slightly, however, significantly lower in patients with coronary heart disease. Moreover, high plasma concentrations of a marker plant sterol, sitosterol, were associated with a markedly reduced risk for coronary heart disease (OR 0.78, CI 0.62-0.98, p<0.05). In contrast neither plant stanols (sitostanol or campestanol) nor the cholesterol synthesis markers (lathosterol, lanosterol and desmosterol) nor their ratios to cholesterol were significantly different in the study groups. These data suggest that plant sterols could have neutral or even protective effects on development of coronary heart disease, which have to be confirmed in interventional trials.

 

Improvement of cholesterol levels and reduction of cardiovascular risk via the consumption of phytosterols.
Br J Nutr.  2006; 96 Suppl 1:S89-93
Ortega RM; Palencia A; López-Sobaler AM
Departamento de Nutrición, Facultad de Farmacia, Universidad Complutense de Madrid, E-28040 Madrid, Spain. rortega@farm.ucm.es  
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.

 

Mayo Clinic Proc. 2003;78:965-978
Efficacy and Safety of Plant Stanols and Sterols in the Management of Blood Cholesterol Levels
MARTIJN B. KATAN, PHD; SCOTT M. GRUNDY, MD, PHD; PETER JONES, PHD; MALCOLM LAW, FRCP; TATU MIETTINEN, MD, PHD; AND RODOLFO PAOLETTI, MD, PHD, FOR THE STRESA WORKSHOP PARTICIPANTS.
Questa analisi riassume le deliberazioni di 32 esperti di lipidemia, nutrizione e malattie cardiovascolari a proposito dell'efficacia e la sicurezza di steroli e stanoli. Una meta-analisi di 41 studi ha evidenziato che l'assunzione di 2 g/d di fitosteroli o stanoli riduce il colesterolo LDL del 10% e che l'efficacia di steroli e stanoli è simile. Quando steroli e stanoli sono integrati in regimi alimentari a basso contenuto di grassi saturi e colesterolo è possibile conseguire riduzioni del colesterolo LDL del 20% o più. Quando si associa l'intervento sul regime alimentare alla terapia farmacologica si ottiene un effetto additivo. Nel corso del workshop è stata inoltre esaminata la sicurezza di fitosteroli e stanoli. In conclusione, le attuali evidenze sono sufficienti per promuovere l'utilizzo di steroli e stanoli al fine di abbassare i livelli di colesterolo LDL nei soggetti con ipercolesterolemia ed elevato rischio di coronaropatia.

Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels.
Katan MB et al., (Stresa Workshop, Italy 2001) Mayo Clin Proc. 2003; 78: 965-978.
Questa analisi riassume le deliberazioni di 32 esperti di lipidemia, nutrizione e malattie cardiovascolari a proposito dell'efficacia e la sicurezza di steroli e stanoli. Una meta-analisi di 41 studi ha evidenziato che l'assunzione di 2 g/d di fitosteroli o stanoli riduce il colesterolo LDL del 10% e che l'efficacia di steroli e stanoli è simile. Quando steroli e stanoli sono integrati in regimi alimentari a basso contenuto di grassi saturi e colesterolo è possibile conseguire riduzioni del colesterolo LDL del 20% o più. Quando si associa l'intervento sul regime alimentare alla terapia farmacologica si ottiene un effetto additivo. Nel corso del workshop è stata inoltre esaminata la sicurezza di fitosteroli e stanoli. In conclusione, le attuali evidenze sono sufficienti per promuovere l'utilizzo di steroli e stanoli al fine di abbassare i livelli di colesterolo LDL nei soggetti con ipercolesterolemia ed elevato rischio di coronaropatia.

Plant sterol ester–enriched spread lowers plasma total and LDL cholesterol in children with familial hypercholesterolemia1,2
Ågot L Amundsen, Leiv Ose, Marit S Nenseter, and Fady Y Ntanios

 

 

^ Inizio