Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Hospital Clínic Barcelona, Spain.
Curr Med Chem. 2019;26(37):6691-6703. doi: 10.2174/0929867325666180709114524.
Plant sterols and stanols (PS) are natural, non-nutritive molecules that play a structural role in plant membranes similar to that of cholesterol in animal membranes and abound in seeds and derived oils. PS exert their physical effect of interference with micellar solubilization of cholesterol within the intestinal lumen and are marginally absorbed by enterocytes, with negiglible increases in circulating levels. The physiological role of PS in plants and their natural origin and non-systemic action, together with their cholesterol-lowering effect, make them an attractive option as non-pharmacological agents for the management of hypercholesterolemia. Recent meta-analyses have summarized the results of >100 controlled clinical trials and have firmly established that the consumption of PS-supplemented foods in different formats at doses of 2-3 g per day results in LDL-cholesterol reductions of 9-12%. PS are both effective and safe cholesterol-lowering agents and have many clinical applications: adjuncts to a healthy diet, treatment of common hypercholesterolemia, combination therapy with statins and other lipid-lowering drugs, and treatment of metabolic syndrome and diabetes. The cholesterol-lowering efficacy is similar in all clinical situations. PS are also useful agents for treatment of hypercholesterolemic children who are not yet candidates to statins or receive low-doses of these agents. In the setting of statin treatment, the average LDL-cholesterol reduction obtained with PS is equivalent to up- titrating twice the statin dose. However, information is still scarce on the efficacy of PS as an add-on therapy to ezetimibe, fibrates, omega- 3 fatty acids, or bile acid binding resins. The consistent scientific evidence on the cholesterollowering efficacy and safety of functional foods supplemented with PS has led several national and international scientific societies to endorse their use for the non-pharmacologic treatment of hypercholesterolemia as adjuncts to a healthy diet. There is, however, a lack of clinical trials of PS with outcomes on cardiovascular events.
植物固醇和甾烷醇（PS）是天然的、非营养性分子，在植物膜中发挥结构作用，类似于动物膜中的胆固醇，并在种子和衍生油中大量存在。PS 通过干扰肠腔中胆固醇的胶束溶解来发挥其物理作用，被肠细胞轻微吸收，对循环水平的胆固醇几乎没有增加。PS 在植物中的生理作用及其天然来源和非系统性作用，以及它们的降胆固醇作用，使它们成为管理高胆固醇血症的非药物治疗的有吸引力的选择。最近的荟萃分析总结了 100 多项对照临床试验的结果，明确证实了以不同形式补充 PS 的食品，剂量为每天 2-3 克，可使 LDL-胆固醇降低 9-12%。PS 是有效且安全的降胆固醇药物，具有多种临床应用：作为健康饮食的辅助治疗、治疗常见高胆固醇血症、与他汀类药物和其他降脂药物联合治疗、治疗代谢综合征和糖尿病。在所有临床情况下，降胆固醇效果相似。PS 对于尚未成为他汀类药物候选者或接受低剂量他汀类药物的高胆固醇血症儿童也是有用的治疗药物。在他汀类药物治疗的情况下，PS 可使 LDL-胆固醇平均降低，相当于将他汀类药物剂量增加两倍。然而，关于 PS 作为依折麦布、贝特类药物、ω-3 脂肪酸或胆汁酸结合树脂的附加治疗的疗效信息仍然很少。关于 PS 作为功能性食品补充剂的降胆固醇疗效和安全性的一致科学证据，促使一些国家和国际科学协会支持将其用于非药物治疗高胆固醇血症，作为健康饮食的辅助治疗。然而，缺乏关于 PS 治疗的临床试验结果与心血管事件相关。
