Vascular effects of diet supplementation with plant sterols.
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.
Weingärtner
Oliver
O
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Lütjohann
Dieter
D
Ji
Shengbo
S
Weisshoff
Nicole
N
List
Franka
F
Sudhop
Thomas
T
von Bergmann
Klaus
K
Gertz
Karen
K
König
Jochem
J
Schäfers
Hans-Joachim
HJ
Endres
Matthias
M
Böhm
Michael
M
Laufs
Ulrich
U
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
D010840:Phytosterols; D028321:Plant Preparations