Phytosterols and stanols are plant derivatives that compete with cholesterol for intestinal absorption and thereby lower serum cholesterol concentrations. They have been developed as food additives to help lower serum cholesterol but there is concern that these additives could inadvertently increase cardiovascular risk. This concern arises from the observation that patients with the rare genetic condition phytosterolemia overabsorb phytosterols and develop premature atherosclerosis. This review evaluates the relationship between phytosterol and stanol supplementation and cardiovascular risk.
Plant sterol supplementation produces minimal increases in blood phytosterol concentrations in humans. Recent animal studies suggest that phytosterols reduce atherosclerosis in the Apo-E deficient mouse model. The evidence from human studies is mixed and does not prove or disprove an increase in atherosclerotic risk from serum phytosterol levels. An increase in risk seems unlikely, but additional studies should address this possibility.
Phytosterols are effective in lowering low-density lipoprotein-cholesterol levels, and do not appear to increase atherosclerotic risk, but additional research on this topic is necessary.
Section of Preventive Cardiology, Division of Cardiology, The Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut, USA
Correspondence to Paul D. Thompson, MD, Cardiology Division, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA Tel: +1 860 545 2899; fax: +1 860 545 2882; e-mail: email@example.com
Conflict of interest: Dr Thompson owns stock in Merck, Pfizer, and Schering-Plough, has received research support from Merck, Pfizer, Schering-Plough, Bristol-Myers Squibb, AstraZeneca, and Kos Pharmaceuticals and has served as either a paid speaker or consultant for Merck, Pfizer, Schering-Plough, Bristol-Myers Squibb, AstraZeneca, and Kos Pharmaceuticals.