Abstract
Purpose
To determine if plant stanols and plant sterols differ with respect to their low-density
lipoprotein cholesterol (LDL-CH) lowering efficacies across a continuous dose range.
Methods
Dose-response relationships were evaluated separately for plant stanols and plant
sterols and reductions in LDL-CH, using a first-order elimination function.
Results
Altogether, 113 publications and 1 unpublished study report (representing 182 strata)
complied with the pre-defined inclusion and exclusion criteria and were included in
the assessment. The maximal LDL-CH reductions for plant stanols (16.4%) and plant
stanol ester (17.1%) were significantly greater than the maximal LDL-CH reductions
for plant sterols (8.3%) and plant sterol ester (8.4%). These findings persisted in
several additional analyses.
Discussion and conclusions
Intakes of plant stanols in excess of the recommended 2 g/day dose are associated with additional and dose-dependent reductions in LDL-CH,
possibly resulting in further reductions in the risk of coronary heart disease (CHD).
Keywords
Abbreviations:
BMI (body mass index), CHD (coronary heart disease), HDL (high-density lipoprotein), LDL-CH (low-density lipoprotein cholesterol)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Prostaglandins, Leukotrienes and Essential Fatty AcidsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
WHO, Cardiovascular Diseases (CVDs), WHO Fact Sheet No. 317, World Health Organization (WHO), Geneva, Switzerland, 2009. Available at: 〈http://www.who.int/mediacentre/factsheets/fs317/en/index.html〉 (Updated September 2009; Last accessed July 6, 2010).
- Treating to protect: current cardiovascular treatment approaches and remaining needs.Medscape J. Med. 2008; 10: S3
NCEP (National Cholesterol Education Program), Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, Final Report), NIH Publication No. 02-5215, National Cholesterol Education Program, National Heart, Lung and Blood Institute and National Institutes of Health, Bethesda (MD), 2002. Available at: 〈http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf〉 (Last accessed July 6, 2010).
- JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. British Cardiac Society; British Hypertension Society; Diabetes UK; HEART UK; Primary Care Cardiovascular Society; Stroke Association.Heart. 2005; 91: v1-v52
- ACC/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute.Circulation. 2006; 113 (published correction appears in Circulation 111, e847): 2363-2372
- Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association.Diabetes Care. 2008; 31: S61-S78
Health Canada, Plant Sterols and Blood Cholesterol Lowering, Health Canada, Food Directorate, Health Products and Food Branch, Bureau of Nutritional Sciences, Ottawa (ON), 2010. Available at: 〈http://www.hc-sc.gc.ca/fn-an/label-etiquet/claims-reclam/assess-evalu/phytosterols-eng.php〉 (Last accessed July 6, 2010).
- Food labeling; health claim; phytosterols and risk of coronary heart disease; proposed rule [21 CFR Part 101, Docket Nos. FDA-2000-P-0102, FDA-2000-P-0133, and FDA-2006-P-0033; Formerly Docket Nos. 2000P-1275, 2000P-1276, and 2006P-0316, respectively].Fed. Regist. (US). 2010; 75 (Available at: 〈http://edocket.access.gpo.gov/2010/pdf/2010-30386.pdf〉 (Last accessed December 20, 2010)): 76525-76571
- Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels.Mayo Clin. Proc. 2003; 78: 965-978
- The comparative efficacy of plant sterols and stanols on serum lipids: a systematic review and meta-analysis.J. Am. Diet. Assoc. 2010; 110: 719-726
- Plant sterol and stanol margarines and health.Br. Med. J. 2000; 320: 861-864
- Continuous dose-response relationship of the LDL-cholesterol-lowering effect of phytosterol intake [plus supplemental data].J. Nutr. 2009; 139: 271-284
- Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Phys. Ther. 2009; 89: 873-880
- Analytical perspective (errors in statistical tests)(3).Emerg. Themes Epidemiol. 2008; 5: 9https://doi.org/10.1186/1742-7622-5-9
A.C. Cameron, P.K. Trivedi, 8.7: Model diagnostics. 8.7.1: pseudo-R2 measures, in: Microeconometrics: Methods and Applications. Cambridge University Press, New York (NY), 2005, pp. 287–289.
- Interpreting the magnitudes of correlation coefficients.Am. Psychol. 2003; 58: 78-79
M. Hallikainen, T.A. Miettinen, H. Gylling, Effect of plant stanol esters on serum lipids, percurosers of cholesterol synthesis and plant sterols in type 1 diabetes on stable statin drug use. Address for correspondence: University of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, Department of Clinical Nutrition, Kuopio, Finland, 2010 (Unpublished manuscript).
M.U. Beer, H. Pritchard, E.M. Belsey, M. Davidson, Effect of a Milk Drink Enriched with Increasing Doses of Free Tall Oil Phytosterols on Plasma Lipid Levels of Mildly Hypercholesteroleamic Subjects. Document submitted by Altus Foods to FDA concerning the interim final rule for Vegetable oil sterol esters and coronary heart disease (Docket Nos. 00P-1275 and 00P-1276) (Unpublished).
- Eficacia hipocolesterolemiante de un yogur que contiene ésteres de estanol vegetal. [Hypocholesteremic effectiveness of a yogurt containing plant stanol esters].Rev. Clin. Esp. 2005; 205: 63-66
- Blood lipid responses to plant stanol ester supplementation and aerobic exercise training.Metabolism. 2006; 55: 541-549
- Cholesterol-lowering effects of a stanol ester-containing low-fat margarine used in conjunction with a strict lipid-lowering diet.Eur. Heart J. 1999; 1: S80-S90
V.G. Athyros, A.I. Kakafika, A.A. Papageorgiou, et al., Effect of a plant stanol ester-containing spread, placebo spread, or Mediterranean diet on estimated cardiovascular risk and lipid, inflammatory and haemostatic factors, Nutr. Metab. Cardiovasc. Dis. (2009) (Epub ahead of print).
- Evaluation of cardiovascular risk and oxidative stress parameters in hypercholesterolemic subjects on a standard healthy diet including low-fat milk enriched with plant sterols.J. Nutr. Biochem. 2010; 21: 881-886
- Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy.Am. J. Cardiol. 2000; 86: 46-52
- Cholesterol-lowering effect of spreads enriched with microcrystalline plant sterols in hypercholesterolemic subjects.Eur. J. Nutr. 2001; 40: 66-73
- Dose-response effects of different plant sterol sources in fat spreads on serum lipids and C-reactive protein and on the kinetic behavior of serum plant sterols.Eur. J. Clin. Nutr. 2008; 62: 968-977
- Safety and tolerability of esterified phytosterols administered in reduced-fat spread and salad dressing to healthy adult men and women.J. Am. Coll. Nutr. 2001; 20: 307-319
- Effects of plant sterol and stanol ester consumption on lipid metabolism, antioxidant status and markers of oxidative stress, endothelial function and low-grade inflammation in patients on current statin treatment.Eur. J. Clin. Nutr. 2008; 62: 263-273
- Effects of long-term plant sterol or stanol ester consumption on lipid and lipoprotein metabolism in subjects on statin treatment.Br. J. Nutr. 2008; 100: 937-941
- Plant sterol-fortified orange juice effectively lowers cholesterol levels in mildly hypercholesterolemic healthy individuals.Arterioscler. Thromb. Vasc. Biol. 2004; 24: e25-e28
- Reduced-calorie orange juice beverage with plant sterols lowers C-reactive protein concentrations and improves the lipid profile in human volunteers.Am. J. Clin. Nutr. 2006; 84: 756-761
- Intake occasion affects the serum cholesterol lowering of a plant sterol-enriched single-dose yoghurt drink in mildly hypercholesterolaemic subjects.Eur. J. Clin. Nutr. 2006; 60: 325-333
- Examination of encapsulated phytosterol ester supplementation on lipid indices associated with cardiovascular disease.Nutrition. 2007; 23: 625-633
- Effects of margarines and butter consumption on lipid profiles, inflammation markers and lipid transfer to HDL particles in free-living subjects with the metabolic syndrome.Eur. J. Clin. Nutr. 2010; 64: 1141-1149
- Effect of plant stanol tablets on low-density lipoprotein cholesterol lowering in patients on statin drugs.Am. J. Cardiol. 2006; 97: 376-379
- Milk enriched with phytosterols reduces plasma cholesterol levels in healthy and hypercholesterolemic subjects.Nutr. Res. 2007; 27: 200-205
- The effect of a very high daily plant stanol ester intake on serum lipids, carotenoids, and fat-soluble vitamins.Clin. Nutr. 2010; 29: 112-118
- Effects of plant stanol esters on serum cholesterol concentrations, relative markers of cholesterol metabolism and endothelial function in type 1 diabetes.Atherosclerosis. 2008; 199: 432-439
- Effects of 2 low-fat stanol ester-containing margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects.Am. J. Clin. Nutr. 1999; 69: 403-410
- Effect of low-fat, fermented milk enriched with plant sterols on serum lipid profile and oxidative stress in moderate hypercholesterolemia.Am. J. Clin. Nutr. 2007; 86: 790-796
- Safety of long-term consumption of plant sterol esters-enriched spread.Eur. J. Clin. Nutr. 2003; 57: 681-692
- Effects of phytosterol ester-enriched low-fat milk on serum lipoprotein profile in mildly hypercholesterolaemic patients are not related to dietary cholesterol or saturated fat intake.Br. J. Nutr. 2010; 104: 1018-1025
- Double-blind, placebo-controlled study of effects of plant sterol enriched vegetable juice on serum cholesterol concentrations in mildly hypercholesterolemic subjects and safety evaluation.J. Oleo Sci. 2006; 55: 593-606
- Decrease in plasma low-density lipoprotein cholesterol, apolipoprotein B, cholesteryl ester transfer protein, and oxidized low-density lipoprotein by plant stanol ester-containing spread: a randomized, placebo-controlled trial.Nutrition. 2003; 19: 369-374
- J et al. Plant stanol esters in low-fat yogurt reduces total and low-density lipoprotein cholesterol and low-density lipoprotein oxidation in normocholesterolemic and mildly hypercholesterolemic subjects.Nutr. Res. 2005; 25: 743-753
- Effects of long-term intake of mayonnaise containing phytosterolester on blood cholesterol concentration in Japanese with borderline of mild cholesterolemia.J. Clin. Biochem. Nutr. 2003; 33: 75-82
- Effects of low-fat hard cheese enriched with plant stanol esters on serum lipids and apolipoprotein B in mildly hypercholesterolaemic subjects.Eur. J. Clin. Nutr. 2006; 60: 1253-1257
- Independent and interactive effects of plant sterols and fish oil n-3 long-chain polyunsaturated fatty acids on the plasma lipid profile of mildly hyperlipidaemic Indian adults.Br. J. Nutr. 2009; 102: 722-732
- Safety aspects and cholesterol-lowering efficacy of low fat dairy products containing plant sterols.Eur. J. Clin. Nutr. 2006; 60: 633-642
- [Minimal effective dose on serum cholesterol concentration and the safety evaluation of dressing containing plant sterol in Japanese subjects].J. Oleo Sci. 2008; 57: 23-33
- [Effects of dressing containing plant sterol on serum cholesterol concentration and the safety evaluation in borderline or mildly hypercholesterolemic Japanese subjects].J. Oleo Sci. 2008; 57: 35-45
- Serum cholesterol-lowering efficacy of stanol ester incorporated in gelatin capsules.Scand. J. Food Nutr. 2006; 50: 124-130
- A phytosterol-enriched spread improves the lipid profile of subjects with type 2 diabetes mellitus-a randomized controlled trial under free-living conditions.Eur. J. Nutr. 2003; 42: 111-117
- Plant sterol-enriched milk tea decreases blood cholesterol concentrations in Chinese adults: a randomised controlled trial.Br. J. Nutr. 2007; 98: 978-983
- Lipid responses to plant-sterol-enriched reduced-fat spreads incorporated into a National Cholesterol Education Program Step I diet.Am. J. Clin. Nutr. 2001; 74: 33-43
- Effects of a phytosterol-enriched dairy product on lipids, sterols and 8-isoprostane in hypercholesterolemic patients: a multicenter Italian study.Nutr. Metab. Cardiovasc. Dis. 2009; 19: 84-90
- A double-blind, placebo-controlled study on the effects of mayonnaise containing free plant sterol on serum cholesterol concentration; safety evaluation for normocholesterolemic and mildly hypercholesterolemic Japanese subjects.J. Oleo Sci. 2004; 53: 79-88
- Minimal effective dose of plant sterol on serum cholesterol concentration in Japanese subjects and safety evaluation of plant sterol supplemented in mayonnaise.J. Oleo Sci. 2004; 53: 17-27
- A single daily dose of soybean phytosterols in ground beef decreases serum total cholesterol and LDL cholesterol in young, mildly hypercholesterolemic men.Am. J. Clin. Nutr. 2002; 76: 57-64
- Phytostanol tablets reduce human LDL-cholesterol.J. Pharm. Pharmacol. 2005; 57: 889-896
- Effects of plant stanol esters supplied in low-fat yoghurt on serum lipids and lipoproteins, non-cholesterol sterols and fat soluble antioxidant concentrations.Atherosclerosis. 2002; 160: 205-213
- Plant stanols dose-dependently decrease LDL-cholesterol concentrations, but not cholesterol-standardized fat-soluble antioxidant concentrations, at intakes up to 9 g/d.Am. J. Clin. Nutr. 2010; 92: 24-33
- Dietary sitostanol related to absorption, synthesis and serum level of cholesterol in different apolipoprotein E phenotypes.Atherosclerosis. 1994; 105: 217-226
- Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population.N. Engl. J. Med. 1995; 333: 1308-1312
- Cholesterol-lowering effect of stanol ester in a US population of mildly hypercholesterolemic men and women: a randomized controlled trial.Mayo Clin. Proc. 1999; 74: 1198-1206
- Effects of yoghurt enriched with free plant sterols on the levels of serum lipids and plant sterols in moderately hypercholesterolaemic subjects on a high-fat diet.Int. J. Food Sci. Nutr. 2008; 59: 357-367
- Plant sterol-enriched fermented milk enhances the attainment of LDL-cholesterol goal in hypercholesterolemic subjects. DANACOL Group.Eur. J. Nutr. 2008; 47: 32-39
- Vegetable oil based versus wood based stanol ester mixtures: effect on serum lipids and hemostatic factors in non-hypercholesterolemic subjects.Atherosclerosis. 2000; 148: 101-112
- Bakery products enriched with phytosterol esters, α-tocopherol and β-carotene decrease plasma LDL-cholesterol and maintain plasma β-carotene concentrations in normocholesterolemic men and women.J. Nutr. 2003; 133: 3103-3109
- Plant stanol ester consumption and arterial elasticity and endothelial function.Br. J. Nutr. 2008; 100: 603-608
- Dose-dependent cholesterol-lowering effect of a mayonnaise-type product with a main component of diacylglycerol-containing plant sterol esters.Nutrition. 2006; 22: 174-178
- Effects of soybean-germ oil on reducing serum cholesterol level.J. Oleo Sci. 2001; 50 (in Japanese): 649-655
- Effects of phytosterol ester-enriched vegetable oil on plasma lipoproteins in healthy men.Asia Pac. J. Clin. Nutr. 2003; 12: 282-291
- Effects of phytosterol ester-enriched vegetable oil on serum cholesterol and assessment of safety in healthy men.J. Oleo Sci. 2003; 52: 205-213
- Vegetable oil enriched with phytosterol ester and the degree of serum cholesterol lowering effect in healthy subjects.J. Oleo Sci. 2003; 52: 285-294
- Plant stanol esters in low-fat milk products lower serum total and LDL cholesterol.Eur. J. Nutr. 2007; 46: 111-117
- Additive effect of plant sterol-ester margarine and cerivastatin in lowering low-density lipoprotein cholesterol in primary hypercholesterolemia.Am. J. Cardiol. 2002; 90: 737-740
- Fat-free foods supplemented with soy stanol-lecithin powder reduce cholesterol absorption and LDL cholesterol.J. Am. Diet. Assoc. 2003; 103: 577-581
- Phytosterols dissolved in diacylglycerol oil reinforce the cholesterol-lowering effect of low-dose pravastatin treatment.Nutr. Metab. Cardiovasc. Dis. 2008; 18: 483-491
- Plant stanol supplementation decreases serum triacylglycerols in subjects with overt hypertriglyceridemia.Lipids. 2009; 44: 1131-1140
- Serum cholesterol, cholesterol precursors, and plant sterols in hypercholesterolemic subjects with different apoE phenotypes during dietary sitostanol ester treatment.J. Lipid Res. 1993; 34: 1535-1544
- Serum levels, absorption efficiency, faecal elimination and synthesis of cholesterol during increasing doses of dietary sitostanol esters in hypercholesterolaemic subjects.Clin. Sci. 1994; 87: 61-67
- Cholesterol malabsorption caused by sitostanol ester feeding and neomycin in pravastatin-treated hypercholesterolaemic patients.Eur. J. Clin. Pharmacol. 1994; 47: 169-176
- Plant sterols and endurance training combine to favorably alter plasma lipid profiles in previously sedentary hypercholesterolemic adults after 8 wk.Am. J. Clin. Nutr. 2004; 80: 1159-1166
- Cholesterol lowering effect of a soy drink enriched with plant sterols in a french population with moderate hypercholesterolemia.Lipids Health Dis. 2008; 7: 35https://doi.org/10.1186/1476-511X-7-35
- Cholesterol-lowering ability of a phytostanol softgel supplement in adults with mild to moderate hypercholesterolemia.Lipids. 2006; 41: 127-132
- Lichtenstein. Intake of a single morning dose of standard and novel plant sterol preparations for 4 weeks does not dramatically affect plasma lipid concentrations in humans.J. Nutr. 2006; 136: 1012-1016
- Responsiveness of plasma lipids and lipoproteins to plant stanol esters.Am. J. Cardiol. 2005; 96: 23D-28D
- Phytosterol intake and dietary fat reduction are independent and additive in their ability to reduce plasma LDL cholesterol.Lipids. 2009; 44: 273-281
- Plant sterol-enriched spread enhances the cholesterol-lowering potential of a fat-reduced diet.Eur. J. Clin. Nutr. 2003; 57: 170-176
- Cholesterol-lowering effects of plant sterol esters differ in milk, yoghurt, bread and cereal.Eur. J. Clin. Nutr. 2004; 58: 503-509
- Increased intake of fruit and vegetables and a low-fat diet, with and without low-fat plant sterol-enriched spread consumption: effects on plasma lipoprotein and carotenoid metabolism.J. Hum. Nutr. Diet. 2004; 17 (& quiz, 571–574): 561-569
- Fitoesteroles circulantes: biomarcadores de la absorcion de los esteroles de la dieta habitual y de adherencia a alimentos suplementados con esteroles vegetales. [Circulating phytosterols: biomarkers of the absorption of sterols in the normal diet and of adherence to vegetable sterol supplemented foods].Actividad Diet. 2010; 14: 3-9
- Basal plasma concentrations of plant sterols can predict LDL-C response to sitosterol in patients with familial hypercholesterolemia.Eur. J. Clin. Nutr. 2008; 62: 495-501
- Apolipoprotein E polymorphism and serum lipid response to plant sterols in humans.Eur. J. Clin. Invest. 2002; 32: 738-742
- Serum cholesterol and cholesterol and lipoprotein metabolism in hypercholestrolaemic NIDDM patients before and during sitostanol ester-margarine treatment.Diabetologia. 1994; 37: 773-780
- Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men.J. Lipid Res. 1996; 37: 1776-1785
- Cholesterol reduction by different plant stanol mixtures and with variable fat intake.Metabolism. 1999; 48: 575-580
- Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine:womenand dietary sitostanol.Circulation. 1997; 96: 4226-4231
- Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolaemic subjects on a low-fat diet.Eur. J. Clin. Nutr. 2000; 54: 715-725
- Nonesterified phytosterols dissolved and recrystallized in oil reduce plasma cholesterol in gerbils and humans.J. Nutr. 2004; 134: 1395-1399
- Plant sterols from rapeseed and tall oils: effects on lipids, fat-soluble vitamins and plant sterol concentrations.Nutr. Metab. Cardiovasc. Dis. 2010; 20: 258-265
- Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects.Eur. J. Clin. Nutr. 1999; 53: 319-327
- Baseline plasma plant sterol concentrations do not predict changes in serum lipids, C-reactive protein (CRP) and plasma plant sterols following intake of a plant sterol-enriched food.Eur. J. Clin. Nutr. 2009; 63: 543-551
- Inhibition of cholesterol absorption by the combination of dietary plant sterols and ezetimibe: effects on plasma lipid levels.J. Lipid Res. 2005; 46: 2692-2698
- Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters.J. Lipid Res. 2000; 41: 697-705
- Plant sterol esters lower plasma lipids and most carotenoids in mildly hypercholesterolemic adults.Lipids. 2002; 37: 33-42
- Efficacy of plant sterols is not influenced by dietary cholesterol intake in hypercholesterolemic individuals.Metabolism. 2008; 57: 339-346
- Similar serum plant sterol responses of human subjects heterozygous for a mutation causing sitosterolemia and controls to diets enriched in plant sterols or stanols [including supplementary table].Eur. J. Clin. Nutr. 2007; 61: 896-905
- Plant sterols are efficacious in lowering plasma LDL and non-HDL cholesterol in hypercholesterolemic type 2 diabetic and nondiabetic persons.Am. J. Clin. Nutr. 2005; 81: 1351-1358
- The human cholesteryl ester transfer protein I405V polymorphism is associated with plasma cholesterol concentration and its reduction by dietary phytosterol esters.J. Nutr. 2003; 133: 1800-1805
- The effect of a combination of plant sterol-enriched foods in mildly hypercholesterolemic subjects.Clin. Nutr. 2007; 26: 792-798
- Effects of phytosterol ester-enriched margarine on plasma lipoproteins in mild to moderate hypercholesterolemia are related to basal cholesterol and fat intake.Metabolism. 2002; 51: 189-194
- Randomised controlled trial of use by hypercholesterolaemic patients of a vegetable oil sterol-enriched fat spread.Atherosclerosis. 2001; 156: 329-337
- Cholesterol-lowering effects of plant sterol esters and non-esterified stanols in margarine, butter and low-fat foods.Eur. J. Clin. Nutr. 2001; 55: 1084-1090
- Plant sterol-enriched margarine lowers plasma LDL in hyperlipidemic subjects with low cholesterol intake: effect of fibrate treatment.Clin. Chem. Lab. Med. 2001; 39: 634-640
- An increase in dietary carotenoids when consuming plant sterols or stanols is effective in maintaining plasma carotenoid concentrations 1–3.Am. J. Clin. Nutr. 2002; 75: 79-86
- Plant sterol ester-enriched milk and yoghurt effectively reduce serum cholesterol in modestly hypercholesterolemic subjects.Eur. J. Nutr. 2005; 44: 214-222
- A spread enriched with plant sterol-esters lowers blood cholesterol and lipoproteins without affecting vitamins A and E in normal and hypercholesterolemic Japanese men and women.J. Nutr. 2002; 132: 3650-3655
- Dietary plant sterols supplementation does not alter lipoprotein kinetics in men with the metabolic syndrome.Asia Pac. J. Clin. Nutr. 2007; 16: 624-631
- A diet moderately enriched in phytosterols lowers plasma cholesterol concentrations in normocholesterolemic humans.Ann. Nutr. Metab. 1995; 39: 291-295
- Effects on serum lipids, lipoproteins and fat soluble antioxidant concentrations of consumption frequency of margarines and shortenings enriched with plant stanol esters.Eur. J. Clin. Nutr. 2000; 54: 671-677
- Dose effects of dietary phytosterols on cholesterol metabolism: a controlled feeding study.Am. J. Clin. Nutr. 2010; 91: 32-38
- Phytosterol-enriched yogurt increases LDL affinity and reduces CD36 expression in polygenic hypercholesterolemia.Lipids. 2009; 44: 153-160
- Spreads enriched with plant sterols, either esterified 4,4-dimethylsterols or free 4-desmethylsterols, and plasma total- and LDL-cholesterol concentrations.Br. J. Nutr. 1999; 82: 273-282
- Effects of a plant sterol-enriched spread on serum lipids and lipoproteins in mildly hypercholesterolaemic subjects.Acta Cardiol. 2002; 57: 111-115
- Effect of free plant sterols in low-fat milk on serum lipid profile in hypercholesterolemic subjects.Eur. J. Clin. Nutr. 2004; 58: 860-870
- Simultaneous intake of β-glucan and plant stanol esters affects lipid metabolism in slightly hypercholesterolemic subjects.J. Nutr. 2007; 137: 583-588
- Unesterified plant sterols and stanols lower LDL-cholesterol concentrations equivalently in hypercholesterolemic persons.Am. J. Clin. Nutr. 2002; 76: 1272-1278
- Effects of yoghurt enriched with plant sterols on serum lipids in patients with moderate hypercholesterolaemia.Br. J. Nutr. 2001; 86: 233-239
- Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects.Eur. J. Clin. Nutr. 1998; 52: 334-343
- Plant stanol and sterol esters in prevention of cardiovascular diseases: a review.Int. J. Clin. Pharmacol. Ther. 2006; 44: 247-250
- Sitostanol administered in lecithin micelles potentially reduces cholesterol absorption in humans.Am. J. Clin. Nutr. 1999; 70: 826-831
- The effects of phytosterols/stanols on blood lipid profiles: a systematic review with meta-analysis.Asia Pac. J. Clin. Nutr. 2009; 18: 179-186
- Plant sterols/stanols as cholesterol lowering agents: a meta-analysis of randomized controlled trials.Food Nutr. Res. 2008; 52 (https://doi.org/10.3402/fnr.v52i0.1811
- for the. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. National Heart Lung and Blood Institute, American College of Cardiology Foundation, and American Heart Association.Circulation. 2004; 110 (published correction appears in Circulation 110(6):763): 227-239
- Pleiotropic effects of statins: benefit beyond cholesterol reduction? A meta-regression analysis.J. Am. Coll. Cardiol. 2005; 46: 1855-1862
- Low-density lipoprotein cholesterol reduction: the end is more important than the means.Am. J. Cardiol. 2007; 100: 240-242
- Cholesterol and heart disease: current concepts in pathogenesis and treatment.J. Natl. Med. Assoc. 1986; 78: 743-751
Article info
Publication history
Published online: February 23, 2011
Accepted:
February 11,
2011
Footnotes
☆Funding for this work was provided by Raisio Nutrition Ltd., Finland.
☆☆Supplementary Tables 1 and 2 and Figs. 1 and 2 are available as Online Supporting Material with the online posting of this paper at http://www.sciencedirect.com/science/journal/09523278.
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: “A comparison of the LDL-cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: Results of a meta-analysis of randomized, placebo controlled trials” by Musa-Veloso K et al., Prostagl. Leucot. Essential Fatty Acids 2011, 85, 9–28Prostaglandins, Leukotrienes and Essential Fatty AcidsVol. 85Issue 1
- PreviewMusa-Veloso et al. have recently published in your journal the results of a meta-analysis with the stated aim of determining whether plant sterols and plant stanols differ in their LDL-cholesterol lowering efficacy across a continuous dose range. This meta-analysis appears thorough in approach and includes data published subsequent to our own recent meta-analysis [1]. However, due to limitations in this type of meta-analysis as well as the amount of available data, we are concerned about the robustness of the conclusion they draw that the maximal LDL-cholesterol reduction achievable with plant stanols is twofold greater than that achievable with plant sterols.
- Full-Text
- Preview
