Gylling Helena, Plat Jogchum, Turley Stephen, Ginsberg Henry N, Ellegård Lars, Jessup Wendy, Jones Peter J, Lütjohann Dieter, Maerz Winfried, Masana Luis, Silbernagel Günther, Staels Bart, Borén Jan, Catapano Alberico L, De Backer Guy, Deanfield John, Descamps Olivier S, Kovanen Petri T, Riccardi Gabriele, Tokgözoglu Lale, Chapman M John
Department of Medicine, Division of Internal Medicine, University of Helsinki, Biomedicum Helsinki, Finland.
Department of Human Biology, Maastricht University, The Netherlands.
Atherosclerosis. 2014 Feb;232(2):346-60. doi: 10.1016/j.atherosclerosis.2013.11.043. Epub 2013 Nov 23.
This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk.
Plant sterols/stanols (when taken at 2 g/day) cause significant inhibition of cholesterol absorption and lower LDL-C levels by between 8 and 10%. The relative proportions of cholesterol versus sterol/stanol levels are similar in both plasma and tissue, with levels of sterols/stanols being 500-/10,000-fold lower than those of cholesterol, suggesting they are handled similarly to cholesterol in most cells. Despite possible atherogenicity of marked elevations in circulating levels of plant sterols/stanols, protective effects have been observed in some animal models of atherosclerosis. Higher plasma levels of plant sterols/stanols associated with intakes of 2 g/day in man have not been linked to adverse effects on health in long-term human studies. Importantly, at this dose, plant sterol/stanol-mediated LDL-C lowering is additive to that of statins in dyslipidaemic subjects, equivalent to doubling the dose of statin. The reported 6-9% lowering of plasma triglyceride by 2 g/day in hypertriglyceridaemic patients warrants further evaluation.
Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are no randomised, controlled clinical trial data with hard end-points to establish clinical benefit from the use of plant sterols or plant stanols.
本欧洲动脉粥样硬化学会（EAS）共识小组严格评估了与添加植物甾醇和/或植物甾烷醇的功能性食品作为健康生活方式的一部分对降低血浆低密度脂蛋白胆固醇（LDL-C）水平从而降低心血管风险的利弊关系相关的证据。
植物甾醇/甾烷醇（每日服用2克时）可显著抑制胆固醇吸收，使LDL-C水平降低8%至10%。血浆和组织中胆固醇与甾醇/甾烷醇水平的相对比例相似，甾醇/甾烷醇水平比胆固醇低500至10000倍，这表明它们在大多数细胞中的处理方式与胆固醇相似。尽管循环中植物甾醇/甾烷醇水平显著升高可能具有致动脉粥样硬化性，但在一些动脉粥样硬化动物模型中已观察到保护作用。在长期人体研究中，人体每日摄入2克植物甾醇/甾烷醇所导致的较高血浆水平并未与对健康的不良影响相关联。重要的是，在此剂量下，植物甾醇/甾烷醇介导的LDL-C降低对血脂异常患者而言与他汀类药物具有相加作用，相当于将他汀类药物剂量翻倍。据报道，高甘油三酯血症患者每日服用2克可使血浆甘油三酯降低6%至9%，这值得进一步评估。
基于LDL-C降低以及无不良信号，本EAS共识小组得出结论，含有植物甾醇/甾烷醇的功能性食品可被考虑用于：1）全球心血管风险处于中低水平、胆固醇水平高且不符合药物治疗条件的个体；2）作为高风险和极高风险患者药物治疗的辅助手段，这些患者在使用他汀类药物时未能达到LDL-C目标或对他汀类药物不耐受；3）以及符合当前指南的患有家族性高胆固醇血症的成人和儿童（>6岁）。然而，必须承认，尚无具有硬终点的随机对照临床试验数据来证实使用植物甾醇或植物甾烷醇的临床益处。
