Qiao Wanning, Feng Hanxiao, Zhang Yi-Feng, Zhang Zhilan, Yang Jinzhao, Wu Manni, Xie Jiyu, Huang Juan, Zhou Tao, Zhang Yang
School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China.
Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China.
Food Funct. 2025 Feb 3;16(3):1157-1168. doi: 10.1039/d4fo05439c.
: Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide, with dietary interventions showing promise in reducing CVD risk factors. Phytosterols (PSs) in plant-based foods may reduce CVD risk by lowering low-density lipoprotein cholesterol. However, the relationship between dietary PS intake and CVD outcomes remains inconclusive. : This study investigated the association between dietary PS intake and CVD outcomes, including coronary heart disease (CHD) and cardiovascular mortality, using a large cohort of 167 209 UK Biobank participants. PS intake was assessed through repeated 24 hour dietary recall data, with participants stratified into quintiles. The Cox proportional-hazards model was used to estimate hazard ratios (HRs) for CVD risk across quintiles of PS intake, adjusting for potential confounders. Restricted cubic splines were used to examine the nonlinear relationship between phytosterol intake and cardiovascular disease risk. Sensitivity and subgroup analyses explored interactions with demographic and lifestyle factors. : Higher dietary PS intake was significantly associated with a reduced risk of CVD events, including CHD and cardiovascular mortality. Each 100 mg increase in PS intake was linked to an 8% reduction in CVD risk (HR = 0.92, 95% CI: 0.87, 0.97). Multivariable-adjusted analyses revealed that participants in the highest quintile of PS intake had significantly lower CVD hazard ratios (HR = 0.81, 95% CI: 0.77, 0.84) compared to those in the lowest quintile. Significant inverse associations were also observed for cardiovascular mortality (HR: 0.86, 95% CI: 0.80, 0.94) and CHD (HR: 0.91, 95% CI: 0.84, 0.98). Subgroup analysis highlighted stronger inverse associations in current smokers, individuals with lower body mass index (BMI), and those with moderate to high physical activity levels, with variations observed based on dyslipidemia status. Sensitivity analyses, excluding early events and adjusting for energy intake, confirmed the robustness of the findings. : This large cohort study provides evidence supporting the cardioprotective effects of dietary PS intake, particularly for CHD and cardiovascular mortality. Dietary PS may be considered an integral component of heart-healthy diets.
心血管疾病（CVDs）仍是全球发病和死亡的主要原因，饮食干预在降低心血管疾病风险因素方面显示出前景。植物性食物中的植物甾醇（PSs）可能通过降低低密度脂蛋白胆固醇来降低心血管疾病风险。然而，饮食中PS摄入量与心血管疾病结局之间的关系仍不明确。
本研究使用来自英国生物银行的167209名参与者的大型队列，调查了饮食中PS摄入量与心血管疾病结局之间的关联，包括冠心病（CHD）和心血管疾病死亡率。通过重复的24小时饮食回忆数据评估PS摄入量，并将参与者分为五等份。使用Cox比例风险模型估计PS摄入量五等份中CVD风险的风险比（HRs），并对潜在混杂因素进行调整。使用受限立方样条来检验植物甾醇摄入量与心血管疾病风险之间的非线性关系。敏感性和亚组分析探讨了与人口统计学和生活方式因素的相互作用。
较高的饮食PS摄入量与CVD事件风险降低显著相关，包括CHD和心血管疾病死亡率。PS摄入量每增加100毫克，CVD风险降低8%（HR = 0.92，95% CI：0.87，0.97）。多变量调整分析显示，PS摄入量最高五分位数的参与者与最低五分位数的参与者相比，CVD风险比显著更低（HR = 0.81，95% CI：0.77，0.84）。在心血管疾病死亡率（HR：0.86，95% CI：0.80，0.94）和CHD（HR：0.91，95% CI：0.84，0.98）方面也观察到显著的负相关。亚组分析强调，在当前吸烟者、体重指数（BMI）较低的个体以及中度至高度身体活动水平的个体中，负相关更强，并且根据血脂异常状况观察到差异。敏感性分析排除早期事件并调整能量摄入量，证实了研究结果的稳健性。
这项大型队列研究提供了证据，支持饮食中PS摄入量的心脏保护作用，特别是对CHD和心血管疾病死亡率。饮食中的PS可被视为心脏健康饮食的一个组成部分。
