Comparison of efficacy of plant stanol ester and sterol ester: short-term and longer-term studies.
Published data suggest that the cholesterol-lowering effect of dietary plant sterol esters is less marked in longer-term than in short-term studies, whereas plant stanol esters maintain their efficacy. To investigate this further, healthy subjects and patients with familial hypercholesterolemia (FH) receiving statins were randomized to receive plant sterol ester 1.6 g/day or plant stanol ester 1.6 g/day or 2.6 g/day for 2 months. There was no difference among the 3 groups in the pooled low-density lipoprotein (LDL)-lowering response of FH patients and healthy subjects, but the effect of plant sterol diminished at 2 months and was not significantly different from baseline. This was accompanied by increases in serum plant sterols and a significant decrease in 7alpha-hydroxy-4-cholesten-3-one, a marker of bile acid synthesis, especially in FH patients not taking bile acid sequestrants. In contrast, plant stanol esters lowered significantly both LDL cholesterol and plant sterols at 2 months and had no effect on bile acid synthesis. Slight decreases in serum lipid-soluble antioxidants occurred with both plant sterol and stanol esters. Our findings suggest that absorption of dietary plant sterols downregulates bile acid synthesis, which attenuates their cholesterol-lowering efficacy. We conclude that plant stanol esters are preferable for the long-term management of hypercholesterolemia.
O'Neill
Frans H
FH
Department of Metabolic Medicine, Division of Investigative Science, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.
Sanders
Tom A B
TA
Thompson
Gilbert R
GR
D001647:Bile Acids and Salts / Q000096:biosynthesis; D008078:Cholesterol, LDL / Q000378:metabolism; D015536:Down-Regulation; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010840:Phytosterols / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D008517:Phytotherapy; D010919:Placebos; D012855:Sitosterols / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D016896:Treatment Outcome
D001647:Bile Acids and Salts; D008078:Cholesterol, LDL; D010840:Phytosterols; D010919:Placebos; D012855:Sitosterols; C407042:plant stanol ester