Hansel B, Courie R, Bayet Y, Delestre F, Bruckert E
Service d'endocrinologie et de prévention cardiovasculaire, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Rev Med Interne. 2011 Feb;32(2):124-9. doi: 10.1016/j.revmed.2010.06.007. Epub 2010 Jul 22.
Phytosterols/stanols (PS) enriched food products have been shown to consistently lower plasma cholesterol levels. The intake of 2g/d of PS decreases LDL-cholesterol by about 10%. With respect to the association of LDL-cholesterol lowering with reduction in the cardiovascular (CV) risk, it is likely that supplementation in PS reduces the incidence of CV disease. In addition, the vast majority of animal studies have shown that oral administration of PS reduces the progression atherosclerosis. However, it has been recently suggested that an increase in PS plasma concentrations may increase CV risk. Evidence to support this hypothesis come mainly from observations in sitosterolemic patients who hyperabsorb PS and cholesterol and display very high levels of PS, which may be associated with a premature atherosclerosis. Some epidemiological studies in non-sitosterolemic subjects have shown a positive correlation between PS plasma levels and coronary heart disease. However, these are observational studies and some of them present major methodological bias. In addition, recent studies with a larger number of subjects have indicated, either an absence or a negative relationship between PS and the incidence of CV disease. The guidelines of several French and international institutions recommend the use of PS enriched food in association with other classical recommendations in hypercholesterolemic subjects. However, further studies are highly encouraged to examine the CV benefit of PS enriched food.
富含植物甾醇/甾烷醇（PS）的食品已被证明能持续降低血浆胆固醇水平。每天摄入2克PS可使低密度脂蛋白胆固醇降低约10%。关于降低低密度脂蛋白胆固醇与降低心血管（CV）风险之间的关联，补充PS可能会降低心血管疾病的发病率。此外，绝大多数动物研究表明，口服PS可减缓动脉粥样硬化的进展。然而，最近有人提出，PS血浆浓度的升高可能会增加心血管风险。支持这一假设的证据主要来自对谷甾醇血症患者的观察，这些患者会过度吸收PS和胆固醇，且PS水平非常高，这可能与过早出现动脉粥样硬化有关。一些针对非谷甾醇血症受试者的流行病学研究表明，PS血浆水平与冠心病之间存在正相关。然而，这些都是观察性研究，其中一些存在重大的方法学偏差。此外，最近针对更多受试者的研究表明，PS与心血管疾病发病率之间不存在关联或呈负相关。法国和一些国际机构的指南建议，在高胆固醇血症患者中，将富含PS的食品与其他传统建议结合使用。然而，强烈鼓励进一步研究，以检验富含PS的食品对心血管的益处。
