Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases—A German Expert Panel Statement
Phytosterols (PSs) have been proposed as dietary means to lower plasma LDL-C. However, concerns are raised that PSs may exert atherogenic effects, which would offset this benefit. Phytosterolemia was thought to mimic increased plasma PSs observed after the consumption of PS-enriched foods. This expe...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/15/4/828 |
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| author | Eberhard Windler Frank-Ulrich Beil Heiner K. Berthold Ioanna Gouni-Berthold Ursula Kassner Gerald Klose Stefan Lorkowski Winfried März Klaus G. Parhofer Jogchum Plat Günter Silbernagel Elisabeth Steinhagen-Thiessen Oliver Weingärtner Birgit-Christiane Zyriax Dieter Lütjohann |
| author_facet | Eberhard Windler Frank-Ulrich Beil Heiner K. Berthold Ioanna Gouni-Berthold Ursula Kassner Gerald Klose Stefan Lorkowski Winfried März Klaus G. Parhofer Jogchum Plat Günter Silbernagel Elisabeth Steinhagen-Thiessen Oliver Weingärtner Birgit-Christiane Zyriax Dieter Lütjohann |
| author_sort | Eberhard Windler |
| collection | DOAJ |
| description | Phytosterols (PSs) have been proposed as dietary means to lower plasma LDL-C. However, concerns are raised that PSs may exert atherogenic effects, which would offset this benefit. Phytosterolemia was thought to mimic increased plasma PSs observed after the consumption of PS-enriched foods. This expert statement examines the possibility of specific atherogenicity of PSs based on sterol metabolism, experimental, animal, and human data. Observational studies show no evidence that plasma PS concentrations would be associated with an increased risk of atherosclerosis or cardiovascular (CV) events. Since variants of the ABCG5/8 transporter affect the absorption of cholesterol and non-cholesterol sterols, Mendelian randomization studies examining the effects of ABCG5/8 polymorphisms cannot support or refute the potential atherogenic effects of PSs due to pleiotropy. In homozygous patients with phytosterolemia, total PS concentrations are ~4000% higher than under physiological conditions. The prevalence of atherosclerosis in these individuals is variable and may mainly relate to concomitant elevated LDL-C. Consuming PS-enriched foods increases PS concentrations by ~35%. Hence, PSs, on a molar basis, would need to have 20–40 times higher atherogenicity than cholesterol to offset their cholesterol reduction benefit. Based on their LDL-C lowering and absence of adverse safety signals, PSs offer a dietary approach to cholesterol management. However, their clinical benefits have not been established in long-term CV endpoint studies. |
| first_indexed | 2024-03-11T08:20:13Z |
| format | Article |
| id | doaj.art-c6af7126e5e7432d9deb69568ac283b4 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-11T08:20:13Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-c6af7126e5e7432d9deb69568ac283b42023-11-16T22:29:32ZengMDPI AGNutrients2072-66432023-02-0115482810.3390/nu15040828Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases—A German Expert Panel StatementEberhard Windler0Frank-Ulrich Beil1Heiner K. Berthold2Ioanna Gouni-Berthold3Ursula Kassner4Gerald Klose5Stefan Lorkowski6Winfried März7Klaus G. Parhofer8Jogchum Plat9Günter Silbernagel10Elisabeth Steinhagen-Thiessen11Oliver Weingärtner12Birgit-Christiane Zyriax13Dieter Lütjohann14Preventive Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Martinistr. 52-Bldg. N26, 20246 Hamburg, GermanyAmbulanzzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of Internal Medicine and Geriatrics, Bethel Clinic, 33611 Bielefeld, GermanyCenter for Endocrinology, Diabetes and Preventive Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, GermanyLipid Clinic at the Interdisciplinary Metabolism Center, Charite-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, GermanyPraxen Dres. T. Beckenbauer & S. Maierhof, Am Markt 11, 28195 Bremen und Dres. I. van de Loo & K. Spieker, Gerold Janssen Straße 2 A, 28359 Bremen, GermanyInstitute of Nutritional Science and Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Friedrich Schiller University Jena, Dornburger Str. 25, 07743 Jena, GermanySYNLAB Akademie für Ärztliche Fortbildung, SYNLAB Holding Deutschland GmbH, P5,7, 68161 Mannheim, GermanyMedizinische Klinik IV, Klinikum der Universität München, Grosshadern, Marchioninistr. 15, 81377 München, GermanyDepartment of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6211 LK Maastricht, The NetherlandsDivision of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8010 Graz, AustriaArbeitsbereich Lipidstoffwechsel der Medizinischen Klinik für Endokrinologie und Stoffwechselmedizin, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, GermanyKlinik für Innere Medizin I, Universitätskliniken Jena, Friedrich-Schiller-Universität Jena, 07743 Jena, GermanyMidwifery Science—Health Care Research and Prevention, Research Group, Preventive Medicine and Nutrition, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyInstitute of Clinical Chemistry and Clinical Pharmacology, University Clinics Bonn, 53127 Bonn, GermanyPhytosterols (PSs) have been proposed as dietary means to lower plasma LDL-C. However, concerns are raised that PSs may exert atherogenic effects, which would offset this benefit. Phytosterolemia was thought to mimic increased plasma PSs observed after the consumption of PS-enriched foods. This expert statement examines the possibility of specific atherogenicity of PSs based on sterol metabolism, experimental, animal, and human data. Observational studies show no evidence that plasma PS concentrations would be associated with an increased risk of atherosclerosis or cardiovascular (CV) events. Since variants of the ABCG5/8 transporter affect the absorption of cholesterol and non-cholesterol sterols, Mendelian randomization studies examining the effects of ABCG5/8 polymorphisms cannot support or refute the potential atherogenic effects of PSs due to pleiotropy. In homozygous patients with phytosterolemia, total PS concentrations are ~4000% higher than under physiological conditions. The prevalence of atherosclerosis in these individuals is variable and may mainly relate to concomitant elevated LDL-C. Consuming PS-enriched foods increases PS concentrations by ~35%. Hence, PSs, on a molar basis, would need to have 20–40 times higher atherogenicity than cholesterol to offset their cholesterol reduction benefit. Based on their LDL-C lowering and absence of adverse safety signals, PSs offer a dietary approach to cholesterol management. However, their clinical benefits have not been established in long-term CV endpoint studies.https://www.mdpi.com/2072-6643/15/4/828plant sterolsphytosterolsphytosterolemiaatherosclerosiscardiovascular diseasecholesterol absorption |
| spellingShingle | Eberhard Windler Frank-Ulrich Beil Heiner K. Berthold Ioanna Gouni-Berthold Ursula Kassner Gerald Klose Stefan Lorkowski Winfried März Klaus G. Parhofer Jogchum Plat Günter Silbernagel Elisabeth Steinhagen-Thiessen Oliver Weingärtner Birgit-Christiane Zyriax Dieter Lütjohann Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases—A German Expert Panel Statement Nutrients plant sterols phytosterols phytosterolemia atherosclerosis cardiovascular disease cholesterol absorption |
| title | Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases—A German Expert Panel Statement |
| title_full | Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases—A German Expert Panel Statement |
| title_fullStr | Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases—A German Expert Panel Statement |
| title_full_unstemmed | Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases—A German Expert Panel Statement |
| title_short | Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases—A German Expert Panel Statement |
| title_sort | phytosterols and cardiovascular risk evaluated against the background of phytosterolemia cases a german expert panel statement |
| topic | plant sterols phytosterols phytosterolemia atherosclerosis cardiovascular disease cholesterol absorption |
| url | https://www.mdpi.com/2072-6643/15/4/828 |
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