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Review
. 2023 Jun 22;15(13):2845.
doi: 10.3390/nu15132845.

Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention

Fotios Barkas  1 , Eirini Bathrellou  2 , Tzortzis Nomikos  2 , Demosthenes Panagiotakos  2 , Evangelos Liberopoulos  3 , Meropi D Kontogianni  2
Affiliations
Review

Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention

Fotios Barkas et al. Nutrients. .

Abstract

Atherosclerotic cardiovascular disease (ASCVD) remains the major mortality cause in developed countries with hypercholesterolaemia being one of the primary modifiable causes. Lifestyle intervention constitutes the first step in cholesterol management and includes dietary modifications along with the use of functional foods and supplements. Functional foods enriched with plant sterols/stanols have become the most widely used nonprescription cholesterol-lowering approach, despite the lack of randomized trials investigating their long-term safety and cardiovascular efficacy. The cholesterol-lowering effect of plant-sterol supplementation is well-established and a potential beneficial impact on other lipoproteins and glucose homeostasis has been described. Nevertheless, experimental and human observational studies investigating the association of phytosterol supplementation or circulating plant sterols with various markers of atherosclerosis and ASCVD events have demonstrated controversial results. Compelling evidence from recent genetic studies have also linked elevated plasma concentrations of circulating plant sterols with ASCVD presence, thus raising concerns about the safety of phytosterol supplementation. Thus, the aim of this review is to provide up-to-date data on the effect of plant sterols/stanols on lipid-modification and cardiovascular outcomes, as well as to discuss any safety issues and practical concerns.

Keywords: cardiovascular disease; cholesterol; functional foods; plant stanols; plant sterols; supplements.

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Conflict of interest statement

E.B., T.Z., D.P. and M.D.K. declare no conflict of interest. F.B. has received honoraria from Amgen, Novartis, Novo Nordisk, and Viatris, not related to the present work. E.L. reports personal fees and nonfinancial support from Amgen, personal fees from Servier, personal fees from Boehringer-Ingelheim, personal fees and nonfinancial support from AstraZeneca, personal fees from MSD, personal fees from Lilly, personal fees and nonfinancial support from Bayer, personal fees from Novartis, and personal fees from Chiesi, not related with the present work.

Figures

Figure 1
Figure 1
Biochemical structure of plant sterols and stanols.
Figure 2
Figure 2
Effect of phytosterol/phytostanol enriched foods on lipids and glucose homeostasis. LDL, low-density lipoprotein; VLDL, very low-density lipoprotein; HDL, high-density lipoprotein; B100, Apolipoprotein B100; C, Apolipoprotein C; E, Apolipoprotein E; A1, Apolipoprotein A1.
See this image and copyright information in PMC

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