Yang Yanhong, Xia Jiayue, Yu Tingqing, Wan Shiyun, Zhou Yajie, Sun Guiju
Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, People's Republic of China.
Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, People's Republic of China.
Phytother Res. 2025 Jan;39(1):3-24. doi: 10.1002/ptr.8308. Epub 2024 Nov 21.
Cardiovascular diseases are the major cause of death globally. The primary risk factors are high blood lipid levels, hypertension, diabetes, and obesity. Phytosterols are naturally occurring plant bioactive substances. Short-term clinical trials have demonstrated phytosterols' cholesterol-lowering potential, but their effects on cardiovascular risk factors remain controversial, and relevant meta-analyses are limited and incomplete. We conducted a systematic and comprehensive search of PubMed, Web of Science, Embase and Cochrane Library up to December 22, 2023. A total of 109 randomized controlled trials (RCTS) of phytosterols (PS) intervention on cardiovascular risk factor outcomes were included in a preliminary screening of the retrieved literature by Endnote 20. We assessed the quality of all included randomized controlled trials using the Cochrane Collaboration's Risk of Bias tool. Cochrane data conversion tool was used for data conversion, and finally Stata was used for meta-analysis, egger test and sensitivity analysis of the included studies. The results indicated that dietary phytosterols intake could significantly decrease total cholesterol (TC) level (mean difference = -13.41; 95% confidence interval [CI]: -15.19, -11.63, p < 0.001), low density lipoprotein cholesterol (LDL-C) level (mean difference = -12.57; 95% CI: -13.87, -11.26, p < 0.001), triglycerides (TG) level (mean difference = -6.34; 95% CI: -9.43, -3.25, p < 0.001), C-reactive protein (CRP) level (mean difference = -0.05; 95% CI: -0.08, -0.01, p = 0.671), systolic blood pressure (SBP) level (mean difference = -2.10; 95% CI: -3.27, -0.9, p < 0.001), diastolic blood pressure (DBP) level (mean difference = -0.83; 95% CI: -0.58, -0.07, p = 0.032), increased high-density lipoprotein cholesterol (HDL-C) level (mean difference = 0.46; 95% CI: 0.13, 0.78, p = 0.005), but did not alter the levels of blood glucose (GLU) (mean difference = -0.44; 95% CI: -1.64, 0.76, p = 0.471), glycosylated hemoglobin, Type A1C (HbA1c) (mean difference = -0.28; 95% CI: -0.75, 0.20, p = 0.251), interleukin-6 (IL-6) (mean difference = 0.00; 95% CI: -0.02, 0.02, p = 0.980), tumor necrosis factor (TNF-α) (mean difference = 0.08; 95% CI: -0.08, 0.24, p = 0.335), oxidized low-density lipoprotein cholesterol (OXLDL-C) (standard mean difference = 0.16; 95% CI: -0.38, 0.06, p = 0.154), body mass index (BMI) (mean difference = 0.01; 95% CI: -0.07, 0.09, p = 0.886), waist circumference (WC) (mean difference = -0.10; 95% CI: -0.50, 0.30, p = 0.625) and body weight (mean difference = 0.03; 95% CI: -0.18, 0.24, p = 0.787). Our results suggest that phytosterols may be beneficial in reducing the levels of TC, LDL-C, TG, CRP, SBP, and DBP, but have no significant effect on GLU, HbA1c, TNF-α, IL-6, OXLDL-C, BMI, WC, and Weight. However, there were a small number of RCTS included in this study and their small population size may have reduced the quality of the study. And most of the included studies were short-term intervention trials. Therefore, higher quality studies need to be designed in future studies to establish more accurate conclusions.
心血管疾病是全球主要的死亡原因。主要风险因素包括高血脂、高血压、糖尿病和肥胖。植物甾醇是天然存在的植物生物活性物质。短期临床试验已证明植物甾醇具有降低胆固醇的潜力，但其对心血管风险因素的影响仍存在争议，相关的荟萃分析有限且不完整。我们对截至2023年12月22日的PubMed、Web of Science、Embase和Cochrane图书馆进行了系统全面的检索。通过Endnote 20对检索到的文献进行初步筛选，共纳入了109项关于植物甾醇（PS）干预心血管危险因素结局的随机对照试验（RCT）。我们使用Cochrane协作网的偏倚风险工具评估了所有纳入的随机对照试验的质量。使用Cochrane数据转换工具进行数据转换，最后使用Stata对纳入研究进行荟萃分析、Egger检验和敏感性分析。结果表明，饮食中摄入植物甾醇可显著降低总胆固醇（TC）水平（平均差值=-13.41；95%置信区间[CI]：-15.19，-11.63，p<0.001）、低密度脂蛋白胆固醇（LDL-C）水平（平均差值=-12.57；95%CI：-13.87，-11.26，p<0.001）、甘油三酯（TG）水平（平均差值=-6.34；95%CI：-9.43，-3.25，p<0.001）、C反应蛋白（CRP）水平（平均差值=-0.05；95%CI：-0.08，-0.01，p=0.671）、收缩压（SBP）水平（平均差值=-2.10；95%CI：-3.27，-0.9，p<0.001）、舒张压（DBP）水平（平均差值=-0.83；95%CI：-0.58，-0.07，p=0.032），升高高密度脂蛋白胆固醇（HDL-C）水平（平均差值=0.46；95%CI：0.13，0.78，p=0.005），但未改变血糖（GLU）水平（平均差值=-0.44；95%CI：-1.64，0.76，p=0.471）、糖化血红蛋白A1C（HbA1c）水平（平均差值=-0.28；95%CI：-0.75，0.20，p=0.251）、白细胞介素-6（IL-6）水平（平均差值=0.00；95%CI：-0.02，0.02，p=0.980）、肿瘤坏死因子（TNF-α）水平（平均差值=0.08；95%CI：-0.08，0.24，p=0.335）、氧化低密度脂蛋白胆固醇（OXLDL-C）水平（标准平均差值=0.16；95%CI：-0.38，0.06，p=0.154）、体重指数（BMI）（平均差值=0.01；95%CI：-0.07，0.09，p=0.886）、腰围（WC）（平均差值=-0.10；95%CI：-0.50，0.30，p=0.625）和体重（平均差值=0.03；95%CI：-0.18，0.24，p=0.787）。我们的结果表明，植物甾醇可能有助于降低TC、LDL-C、TG、CRP、SBP和DBP水平，但对GLU、HbA1c、TNF-α、IL-6、OXLDL-C、BMI、WC和体重没有显著影响。然而，本研究纳入的RCT数量较少，且样本量较小，可能降低了研究质量。并且纳入的研究大多为短期干预试验。因此，未来需要设计更高质量的研究以得出更准确的结论。
