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The Comparative Efficacy of Plant Sterols and Stanols on Serum Lipids: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.jada.2010.02.011Get rights and content

Abstract

Background

Plant sterols and stanols are plant steroids with a similar chemical structure and cellular function to human cholesterol, and are recommended as dietary modifiers of serum lipids. Plant sterols have a higher degree of absorption than plant stanols, suggesting differential efficacy between the two.

Design

A meta-analysis of randomized controlled trials was performed to summarize direct comparisons between the effect of plant sterols vs plant stanols on serum lipid levels in healthy patients and patients with hypercholesterolemia.

Methods

A systematic literature search of MEDLINE, EMBASE, Cochrane CENTRAL, and the Natural Medicines Comprehensive Database was conducted from January 1950 through January 2009. Trials were included in the analysis if they were randomized controlled trials evaluating the effect of plant sterols vs plant stanols in healthy patients or patients with hypercholesterolemia who reported efficacy data on total, low-density lipoprotein, and high-density lipoprotein cholesterols or triglycerides. The weighted mean difference (WMD) of the change from baseline (in mg/dL) with 95% confidence interval was calculated as the difference between the means in the plant sterol and plant stanol groups using a random-effects model.

Results

Fourteen studies (n=531 patients) met the inclusion criteria. Upon meta-analysis, the results showed that there is no statistically or clinically significant difference between plant sterols and plant stanols in their abilities to modify total cholesterol (WMD −1.11 mg/dL [−0.0286 mmol/L], 95% confidence interval [CI] −4.12 to 1.90, P=0.47), low-density lipoprotein cholesterol (WMD −0.35 mg/dL [−0.0091 mmol/L], 95% CI −2.98 to 2.28, P=0.79), high-density lipoprotein cholesterol (WMD −0.28 mg/dL [–0.00073 mmol/L], 95% CI −1.18 to 0.62, P=0.54), or triglycerides (WMD −1.80 mg/dL [−0.0203 mmol/L], 95% CI −6.80 to 3.21, P=0.48).

Conclusions

Plant sterols and plant stanols do not have statistically or clinically relevant differing effects on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or triglyceride levels. The selection of plant sterols vs plant stanols should then be based on potential differences in safety parameters and further study is required to elucidate such differences.

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

References (34)

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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

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