ResearchOriginal ResearchThe Comparative Efficacy of Plant Sterols and Stanols on Serum Lipids: A Systematic Review and Meta-Analysis
Section snippets
Methods
A systematic literature search of MEDLINE (from 1950), EMBASE (from 1990), Cochrane CENTRAL (indexed January 2009), and the Natural Medicines Comprehensive Database was conducted through January 2009. A search strategy was performed using the Medical Subject Headings and text keywords: sterol, stanol, sitosterol, sitostanol, beta-sitosterol, beta-sitostanol, phytosterol, phytostanol, stanol ester, sterol ester in combination with lipids, cholesterol, hypercholesterolemia, hypercholesterolemic,
Study Characteristics
A total of 14 randomized controlled trials (n= 531 patients) met all inclusion criteria (7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20). All 14 trials reported usable data for total cholesterol, whereas 13 trials (7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19) reported useable data for LDL cholesterol, HDL cholesterol, and triglycerides (Figure 1). Eleven trials (7, 9, 10, 11, 13, 14, 15, 16, 17, 19, 20) enrolled patients with hypercholesterolemia, whereas three trials (8, 12, 18)
Discussion
Meta-analysis of 14 randomized controlled trials evaluating the effect of plant sterols vs plant stanols at doses of 0.6 to 2.5 g/day in healthy patients and patients with hypercholesterolemia showed no significantly different effects between the two on total cholesterol, LDL cholesterol, HDL cholesterol, or triglyceride levels. The subgroup and sensitivity analyses revealed no difference in lipid effects when using plant sterols or plant stanols regardless of the trial design (parallel or
Conclusions
Based on the current literature it appears that plant sterols and stanols have similar effects on total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels. Further study is required to determine the long-term efficacy of plant sterols and plant stanols, on not only lipid parameters but on CHD risk. In addition, long-term safety must also be established. At this time, effects on lipid parameters appear similar, so the decision of which to use should be based on safety
R. Talati is a senior research scientist, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford
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R. Talati is a senior research scientist, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford
D. M. Sobieraj is a senior research scientist, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford
O. J. Phung is a senior research scientist, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford
S. S. Makanji is a research scientist, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford
C. I. Coleman is an associate professor of pharmacy practice, School of Pharmacy, and methods chief and program director, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford