Katan Martijn B, Grundy Scott M, Jones Peter, Law Malcolm, Miettinen Tatu, Paoletti Rodolfo
Division of Human Nutrition and Epidemiology, Wageningen University, Bomenweg 2, 6703 HD Wageningen, The Netherlands.
Mayo Clin Proc. 2003 Aug;78(8):965-78. doi: 10.4065/78.8.965.
Foods with plant stanol or sterol esters lower serum cholesterol levels. We summarize the deliberations of 32 experts on the efficacy and safety of sterols and stanols. A meta-analysis of 41 trials showed that intake of 2 g/d of stanols or sterols reduced low-density lipoprotein (LDL) by 10%; higher intakes added little. Efficacy is similar for sterols and stanols, but the food form may substantially affect LDL reduction. Effects are additive with diet or drug interventions: eating foods low in saturated fat and cholesterol and high in stanols or sterols can reduce LDL by 20%; adding sterols or stanols to statin medication is more effective than doubling the statin dose. A meta-analysis of 10 to 15 trials per vitamin showed that plasma levels of vitamins A and D are not affected by stanols or sterols. Alpha carotene, lycopene, and vitamin E levels remained stable relative to their carrier molecule, LDL. Beta carotene levels declined, but adverse health outcomes were not expected. Sterol-enriched foods increased plasma sterol levels, and workshop participants discussed whether this would increase risk, in view of the marked increase of atherosclerosis in patients with homozygous phytosterolemia. This risk is believed to be largely hypothetical, and any increase due to the small increase in plasma plant sterols may be more than offset by the decrease in plasma LDL. There are insufficient data to suggest that plant stanols or sterols either prevent or promote colon carcinogenesis. Safety of sterols and stanols is being monitored by follow-up of samples from the general population; however, the power of such studies to pick up infrequent increases in common diseases, if any exist, is limited. A trial with clinical outcomes probably would not answer remaining questions about infrequent adverse effects. Trials with surrogate end points such as intima-media thickness might corroborate the expected efficacy in reducing atherosclerosis. However, present evidence is sufficient to promote use of sterols and stanols for lowering LDL cholesterol levels in persons at increased risk for coronary heart disease.
含植物甾烷醇或甾醇酯的食物可降低血清胆固醇水平。我们总结了32位专家关于甾醇和甾烷醇的功效及安全性的讨论。对41项试验的荟萃分析表明，每天摄入2克甾烷醇或甾醇可使低密度脂蛋白（LDL）降低10%；摄入量更高时效果增加不多。甾醇和甾烷醇的功效相似，但食物形式可能会显著影响LDL的降低效果。其效果与饮食或药物干预具有相加性：食用饱和脂肪和胆固醇含量低、甾烷醇或甾醇含量高的食物可使LDL降低20%；在他汀类药物中添加甾醇或甾烷醇比将他汀类药物剂量加倍更有效。对每种维生素进行10至15项试验的荟萃分析表明，维生素A和D的血浆水平不受甾烷醇或甾醇的影响。α-胡萝卜素、番茄红素和维生素E的水平相对于其载体分子LDL保持稳定。β-胡萝卜素水平下降，但预计不会产生不良健康后果。富含甾醇的食物会使血浆甾醇水平升高，鉴于纯合子植物甾醇血症患者动脉粥样硬化显著增加，研讨会参与者讨论了这是否会增加风险。这种风险在很大程度上被认为是假设性的，血浆植物甾醇的小幅增加所导致的任何风险增加可能会被血浆LDL的降低所抵消。没有足够的数据表明植物甾烷醇或甾醇能预防或促进结肠癌的发生。正在通过对普通人群样本的随访来监测甾醇和甾烷醇的安全性；然而，此类研究发现常见疾病中罕见增加情况（如果存在的话）的能力有限。一项具有临床结果的试验可能无法回答关于罕见不良反应的剩余问题。采用诸如内膜中层厚度等替代终点的试验可能会证实降低动脉粥样硬化的预期功效。然而，目前的证据足以促进在冠心病风险增加的人群中使用甾醇和甾烷醇来降低LDL胆固醇水平。
