Phytosterols in the prevention and treatment of cardiovascular diseases Review article
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Published:
Dec 1, 2024
Keywords:
phytosterols, fatty acids, diet, cholesterol, dyslipidemia, atherosclerosis, cardiovascular diseases
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Abstract
Cardiovascular diseases are the leading cause of death worldwide and are also an important factor in reducing quality of life. Modifiable factors, including diet, physical activity, stimulants, and dietary supplementation, are most important in preventing and treating cardiovascular diseases. An abnormal fatty acid profile (high intake of saturated while low supply of monounsaturated and polyunsaturated fatty acids), a sedentary lifestyle, or alcohol abuse are factors that promote lipoprotein metabolic disorders and overweight/obesity, which in turn, are absolute risk factors for cardiovascular diseases. On the other hand, practicing regular, moderate-intensity physical activity, eating nutrient-dense, low-processed foods, and introducing functional foods and nutraceuticals containing phytosterols into the diet, the positive effects of which have been confirmed by numerous studies, have shown beneficial effects. The latter aims to support the achievement of therapeutic goals in the concentration of total cholesterol and its fraction. This is possible due to the limiting effect of phytosterols on intestinal absorption of cholesterol and, at the same time, increasing its excretion with feces, resulting in a reduction in plasma LDL-cholesterol and total cholesterol concentrations. This effect is dose-dependent. Taking plant sterols at a dose of about 2 g/day is considered beneficial, translating into a reduced LDL-cholesterol and total cholesterol by about 7–10%.
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How to Cite
Bzikowska-Jura, A. (2024). Phytosterols in the prevention and treatment of cardiovascular diseases. Medycyna Faktow (J EBM), 17(3(64), 375-379. https://doi.org/10.24292/01.MF.0324.10
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24. Jiménez-Escrig A, Santos-Hidalgo AB, Saura-Calixto F. Common sources and estimated intake of plant sterols in the Spanish diet. J Agric Food Chem. 2006; 54: 3462-71.
25. Jaceldo-Siegl K, Lütjohann D, Sirirat R et al. Variations in dietary intake and plasma concentrations of plant sterols across plant-based diets among North American adults. Mol Nutr Food Res. 2017; 61: 1600828.
26. Stellaard F, von Bergmann K, Sudhop T et al. The value of surrogate markers to monitor cholesterol absorption, synthesis and bioconversion to bile acids under lipid lowering therapies. J Steroid Biochem Mol Biol. 2017; 169: 111-22.
27. Witkowska AM, Waśkiewicz A, Zujko ME et al. Assessment of Plant Sterols in the Diet of Adult Polish Population with the Use of a Newly Developed Database. Nutrients. 2021; 13(8): 2722.
28. Ferguson JJ, Stojanovski E, MacDonald-Wicks L et al. Fat type in phytosterol products influence their cholesterol-lowering potential: a systematic review and meta-analysis of RCTs. Prog Lipid Res. 2016; 64: 16-29.
29. Ras RT, Hiemstra H, Lin Y et al. Consumption of plant sterol-enriched foods and effects on plasma plant sterol concentrations – a meta-analysis of randomized controlled studies. Atherosclerosis. 2013; 230: 336-46.
30. Plant Stanols and Plant Sterols and Blood LDL-Cholesterol – Scientific Opinion of the Panel on Dietetic Products Nutrition and Allergies on a request from the European Commission and a similar request from France in relation to the authorization procedure for health claims on plant stanols and plant sterols and lowering/reducing blood LDL-cholesterol pursuant to Article 14 of Regulation (EC) No 1924/2006. The EFSA Journal. 2009; 1175: 1-9.
31. Demonty I, Ras RT, van der Knaap HC et al. The effect of plant sterols on serum triglyceride concentrations is dependent on baseline concentrations: a pooled analysis of 12 randomised controlled trials. Eur J Nutr. 2013; 52: 153-60.
32. Athyros VG, Kakafika AI, Papageorgiou AA et al. Effect of a plant stanol ester- containing spread, placebo spread, or Mediterranean diet on estimated cardio- vascular risk and lipid, inflammatory and haemostatic factors. Nutr Metab Cardiovasc Dis. 2011; 21: 213-21.
2. Główny Urząd Statystyczny (GUS).
3. Pająk A, Szafraniec K, Polak M et al.; WOBASZ Investigators. Changes in the prevalence, treatment, and control of hypercholesterolemia and other dyslipidemias over 10 years in Poland: the WOBASZ study. Pol Arch Med Wewn. 2016; 126(9): 642-52.
4. Sytuacja zdrowotna ludności Polski i jej uwarunkowania 2022. Wojtyniak B, Goryński P. (eds). Narodowy Instytut Zdrowia Publicznego PZH – Państwowy Instytut Badawczy, Warszawa 2022.
5. Gylling H, Plat J, Turley S et al. Plant sterols and plant stanols in the management of dyslipidemia and prevention of cardiovascular disease. Atherosclerosis. 2014; 232: 346-60.
6. Trautwein EA, Koppenol WP, de Jong A et al. Plant sterols lower LDL-cholesterol and triglycerides in dyslipidemic individuals with or at risk of developing type 2 diabetes; a randomized, double-blind, placebo-controlled study. Nutr. Diabetes. 2018; 8: 30.
7. Wang L, Feng L, Prabahar K et al. The effect of phytosterol supplementation on lipid profile: A critical umbrella review of interventional meta- analyses. Phytother Res. 2024; 38(2): 507-19.
8. Cicero AFG, Fogacci F, Giovannini M et al. The Effect of Dietary Supplementation with Plant Sterols on Total and LDL-Cholesterol in Plasma Is Affected by Adherence to Mediterranean Diet: Insights from the DESCO Randomized Clinical Study. Nutrients. 2023; 15: 4555.
9. Banach M, Burchardt P, Chlebus K et al. Wytyczne PTL/KLRwP/PTK/PTDL/PTD/PTNT Diagnostyki i leczenia zaburzeń lipidowych w Polsce 2021. Lekarz POZ Suplement. 2021.
10. NCD Risk Factor Collaboration (NCD-RisC). National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: a pooled analysis of 458 population-based studies in Asian and Western countries. Int J Epidemiol. 2020; 49(1): 173-92.
11. NCD Risk Factor Collaboration (NCD-RisC). Repositioning of the global epicentre of non-optimal cholesterol. Nature. 2020; 582(7810): 73-7.
12. Mach F, Baigent C, Catapano AL et al. ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020; 41(1): 111-88.
13. Riccardi G, Vaccaro O, Costabile G et al. How Well Can We Control Dyslipidemias Through Lifestyle Modifications? Curr Cardiol Rep. 2016; 18(7): 66.
14. Nordmann AJ, Nordmann A, Briel M et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta- analysis of randomized controlled trials. Arch Intern Med. 2006; 166(3): 285-93.
15. Shaw K, Gennat H, O’Rourke P et al. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006(4): CD003817.
16. Zhubi-Bakija F, Bajraktari G, Bytyçi I et al.; International Lipid Expert Panel (ILEP). The impact of type of dietary protein, animal versus vegetable, in modifying cardiometabolic risk factors: A position paper from the International Lipid Expert Panel (ILEP). Clin Nutr. 2021; 40(1): 255-76.
17. Brien SE, Ronksley PE, Turner BJ et al. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ. 2011; 342: d636.
18. Cosentino F, Grant PJ, Aboyans V et al. ; The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020; 41(2): 255-323.
19. Huffman KM, Hawk VH, Henes ST et al. Exercise effects on lipids in persons with varying dietary patterns-does diet matter if they exercise? Responses in Studies of a Targeted Risk Reduction Intervention through Defined Exercise I. Am Heart J. 2012; 164(1): 117-24.
20. Hany M, Demerdash HM, Abouelnasr AA et al. Relationship Between Weight Loss, Changes in Serum hs-CRP Levels and apo A-1 Lipoprotein, and High-Density Lipoprotein-Cholesterol Ratios as Predictors for Improved Cardiovascular Risk Factors After Laparoscopic Sleeve Gastrectomy. Obes Surg. 2024; 34(9): 3401-11.
21. Nestel P. Trans fatty acids: are its cardiovascular risks fully appreciated? Clin Ther. 2014; 36: 315-21
22. Maeda K, Noguchi Y, Fukui T. The effects of cessation from cigarette smoking on the lipid and lipoprotein profiles: a meta-analysis. Prev Med. 2003; 37(4): 283-90.
23. Dutta PC. Phytosterols as Functional Food Components and Nutraceuticals. CRC Press, Boca Raton 2019: 450.
24. Jiménez-Escrig A, Santos-Hidalgo AB, Saura-Calixto F. Common sources and estimated intake of plant sterols in the Spanish diet. J Agric Food Chem. 2006; 54: 3462-71.
25. Jaceldo-Siegl K, Lütjohann D, Sirirat R et al. Variations in dietary intake and plasma concentrations of plant sterols across plant-based diets among North American adults. Mol Nutr Food Res. 2017; 61: 1600828.
26. Stellaard F, von Bergmann K, Sudhop T et al. The value of surrogate markers to monitor cholesterol absorption, synthesis and bioconversion to bile acids under lipid lowering therapies. J Steroid Biochem Mol Biol. 2017; 169: 111-22.
27. Witkowska AM, Waśkiewicz A, Zujko ME et al. Assessment of Plant Sterols in the Diet of Adult Polish Population with the Use of a Newly Developed Database. Nutrients. 2021; 13(8): 2722.
28. Ferguson JJ, Stojanovski E, MacDonald-Wicks L et al. Fat type in phytosterol products influence their cholesterol-lowering potential: a systematic review and meta-analysis of RCTs. Prog Lipid Res. 2016; 64: 16-29.
29. Ras RT, Hiemstra H, Lin Y et al. Consumption of plant sterol-enriched foods and effects on plasma plant sterol concentrations – a meta-analysis of randomized controlled studies. Atherosclerosis. 2013; 230: 336-46.
30. Plant Stanols and Plant Sterols and Blood LDL-Cholesterol – Scientific Opinion of the Panel on Dietetic Products Nutrition and Allergies on a request from the European Commission and a similar request from France in relation to the authorization procedure for health claims on plant stanols and plant sterols and lowering/reducing blood LDL-cholesterol pursuant to Article 14 of Regulation (EC) No 1924/2006. The EFSA Journal. 2009; 1175: 1-9.
31. Demonty I, Ras RT, van der Knaap HC et al. The effect of plant sterols on serum triglyceride concentrations is dependent on baseline concentrations: a pooled analysis of 12 randomised controlled trials. Eur J Nutr. 2013; 52: 153-60.
32. Athyros VG, Kakafika AI, Papageorgiou AA et al. Effect of a plant stanol ester- containing spread, placebo spread, or Mediterranean diet on estimated cardio- vascular risk and lipid, inflammatory and haemostatic factors. Nutr Metab Cardiovasc Dis. 2011; 21: 213-21.