Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases-A German Expert Panel Statement
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Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases-A German Expert Panel Statement. / Windler, Eberhard; Beil, Frank-Ulrich; Berthold, Heiner K; Gouni-Berthold, Ioanna; Kassner, Ursula; Klose, Gerald; Lorkowski, Stefan; März, Winfried; Parhofer, Klaus G; Plat, Jogchum; Silbernagel, Günter; Steinhagen-Thiessen, Elisabeth; Weingärtner, Oliver; Zyriax, Birgit-Christiane; Lütjohann, Dieter.
in: NUTRIENTS, Jahrgang 15, Nr. 4, 06.02.2023, S. 828.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Phytosterols and Cardiovascular Risk Evaluated against the Background of Phytosterolemia Cases-A German Expert Panel Statement
AU - Windler, Eberhard
AU - Beil, Frank-Ulrich
AU - Berthold, Heiner K
AU - Gouni-Berthold, Ioanna
AU - Kassner, Ursula
AU - Klose, Gerald
AU - Lorkowski, Stefan
AU - März, Winfried
AU - Parhofer, Klaus G
AU - Plat, Jogchum
AU - Silbernagel, Günter
AU - Steinhagen-Thiessen, Elisabeth
AU - Weingärtner, Oliver
AU - Zyriax, Birgit-Christiane
AU - Lütjohann, Dieter
PY - 2023/2/6
Y1 - 2023/2/6
N2 - Phytosterols (PSs) have been proposed as dietary means to lower plasma LDL-C. However, concerns are raised that PSs may exert atherogenic effects, which would offset this benefit. Phytosterolemia was thought to mimic increased plasma PSs observed after the consumption of PS-enriched foods. This expert statement examines the possibility of specific atherogenicity of PSs based on sterol metabolism, experimental, animal, and human data. Observational studies show no evidence that plasma PS concentrations would be associated with an increased risk of atherosclerosis or cardiovascular (CV) events. Since variants of the ABCG5/8 transporter affect the absorption of cholesterol and non-cholesterol sterols, Mendelian randomization studies examining the effects of ABCG5/8 polymorphisms cannot support or refute the potential atherogenic effects of PSs due to pleiotropy. In homozygous patients with phytosterolemia, total PS concentrations are ~4000% higher than under physiological conditions. The prevalence of atherosclerosis in these individuals is variable and may mainly relate to concomitant elevated LDL-C. Consuming PS-enriched foods increases PS concentrations by ~35%. Hence, PSs, on a molar basis, would need to have 20-40 times higher atherogenicity than cholesterol to offset their cholesterol reduction benefit. Based on their LDL-C lowering and absence of adverse safety signals, PSs offer a dietary approach to cholesterol management. However, their clinical benefits have not been established in long-term CV endpoint studies.
AB - Phytosterols (PSs) have been proposed as dietary means to lower plasma LDL-C. However, concerns are raised that PSs may exert atherogenic effects, which would offset this benefit. Phytosterolemia was thought to mimic increased plasma PSs observed after the consumption of PS-enriched foods. This expert statement examines the possibility of specific atherogenicity of PSs based on sterol metabolism, experimental, animal, and human data. Observational studies show no evidence that plasma PS concentrations would be associated with an increased risk of atherosclerosis or cardiovascular (CV) events. Since variants of the ABCG5/8 transporter affect the absorption of cholesterol and non-cholesterol sterols, Mendelian randomization studies examining the effects of ABCG5/8 polymorphisms cannot support or refute the potential atherogenic effects of PSs due to pleiotropy. In homozygous patients with phytosterolemia, total PS concentrations are ~4000% higher than under physiological conditions. The prevalence of atherosclerosis in these individuals is variable and may mainly relate to concomitant elevated LDL-C. Consuming PS-enriched foods increases PS concentrations by ~35%. Hence, PSs, on a molar basis, would need to have 20-40 times higher atherogenicity than cholesterol to offset their cholesterol reduction benefit. Based on their LDL-C lowering and absence of adverse safety signals, PSs offer a dietary approach to cholesterol management. However, their clinical benefits have not been established in long-term CV endpoint studies.
KW - Animals
KW - Humans
KW - Hypercholesterolemia
KW - Cholesterol, LDL
KW - Cardiovascular Diseases/chemically induced
KW - Risk Factors
KW - Phytosterols/pharmacology
KW - Cholesterol
KW - Heart Disease Risk Factors
KW - Atherosclerosis/chemically induced
U2 - 10.3390/nu15040828
DO - 10.3390/nu15040828
M3 - SCORING: Journal article
C2 - 36839186
VL - 15
SP - 828
JO - NUTRIENTS
JF - NUTRIENTS
SN - 2072-6643
IS - 4
ER -