title: Vascular effects of diet supplementation with plant sterols.
abstract: OBJECTIVE
  The purpose of this study was to evaluate vascular effects of diet supplementation with plant sterol esters (PSE).
  
  
  BACKGROUND
  Plant sterol esters are used as food supplements to reduce cholesterol levels. Their effects on endothelial function, stroke, or atherogenesis are not known.
  
  
  METHODS
  In mice, plasma sterol concentrations were correlated with endothelial function, cerebral lesion size, and atherosclerosis. Plasma and tissue sterol concentrations were measured by gas-liquid chromatography-mass spectrometry in 82 consecutive patients with aortic stenosis.
  
  
  RESULTS
  Compared with those fed with normal chow (NC), wild-type mice fed with NC supplemented with 2% PSE showed increased plant sterol but equal cholesterol plasma concentrations. The PSE supplementation impaired endothelium-dependent vasorelaxation and increased cerebral lesion size after middle cerebral artery occlusion. To test the effects of cholesterol-lowering by PSE, apolipoprotein E (ApoE)-/- mice were randomized to Western-type diet (WTD) with the addition of PSE or ezetimibe (EZE). Compared with WTD, both interventions reduced plaque sizes; however, WTD + PSE showed larger plaques compared with WTD + EZE (20.4 +/- 2.1% vs. 10.0 +/- 1.5%). Plant sterol plasma concentration strongly correlated with increased atherosclerotic lesion formation (r = 0.50). Furthermore, we examined plasma and aortic valve concentrations of plant sterol in 82 consecutive patients with aortic stenosis. Patients eating PSE-supplemented margarine (n = 10) showed increased plasma concentrations and 5-fold higher sterol concentrations in aortic valve tissue.
  
  
  CONCLUSIONS
  Food supplementation with PSE impairs endothelial function, aggravates ischemic brain injury, effects atherogenesis in mice, and leads to increased tissue sterol concentrations in humans. Therefore, prospective studies are warranted that evaluate not only effects on cholesterol reduction, but also on clinical endpoints.
authors.affiliation: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Weingärtner
authors.forename: Dieter
authors.initials: D
authors.lastname: Lütjohann
authors.forename: Shengbo
authors.initials: S
authors.lastname: Ji
authors.forename: Nicole
authors.initials: N
authors.lastname: Weisshoff
authors.forename: Franka
authors.initials: F
authors.lastname: List
authors.forename: Thomas
authors.initials: T
authors.lastname: Sudhop
authors.forename: Klaus
authors.initials: K
authors.lastname: von Bergmann
authors.forename: Karen
authors.initials: K
authors.lastname: Gertz
authors.forename: Jochem
authors.initials: J
authors.lastname: König
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
mesh_terms: D000368:Aged; D000818:Animals; D001161:Arteriosclerosis / Q000503:physiopathology / Q000517:prevention & control*; D002545:Brain Ischemia / Q000503:physiopathology / Q000517:prevention & control*; D002319:Cardiovascular System / Q000187:drug effects*; D019587:Dietary Supplements; D004727:Endothelium / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D010840:Phytosterols / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D028321:Plant Preparations; D012307:Risk Factors
chemical_list: D010840:Phytosterols; D028321:Plant Preparations