Review Article: Effects of Plant Sterols and Stanols Beyond Low-Density Lipoprotein Cholesterol Lowering

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  • Christos S. Derdemezis
    Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
  • Theodosios D. Filippatos
    Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London (UCL), London, United Kingdom
  • Dimitri P. Mikhailidis
    Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London (UCL), London, United Kingdom
  • Moses S. Elisaf
    Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece,

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<jats:p> Consumption of foods and supplements enriched with plant sterols/stanols (PS) may help reduce low-density lipoprotein cholesterol (LDL-C) levels. In this review, we consider the effects of PS beyond LDL-C lowering. Plant sterols/stanols exert beneficial effects on other lipid variables, such as apolipoprotein (apo) B/apoAI ratio and, in some studies, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Plant sterols/stanols may also affect inflammatory markers, coagulation parameters, as well as platelet and endothelial function. Evidence also exists about a beneficial effect on oxidative stress, but this does not seem to be of greater degree than that expected from the LDL-C lowering. Many of these effects have been demonstrated in vitro and animal models. Some in vitro effects cannot be seen in vivo or in humans at usual doses. The epidemiological studies that evaluated the association of plasma PS concentration with cardiovascular disease (CVD) risk do not provide a definitive answer. Long-term randomized placebo-controlled studies are required to clarify the effects of supplementation with PS on CVD risk and progression of atherosclerosis. </jats:p>

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