Abstract P088: The Cholesterol-Lowering Effect of Phytosterols across Different Dose Ranges: A Meta-analysis of Randomized Controlled Trials
Introduction: Phytosterols (plant sterols and stanols) are proven to lower LDL-cholesterol (LDL-C). Recent evidence suggests a larger maximal lowering effect for plant stanols vs. plant sterols based on their respective continuous dose-response relationships. The objective of the present analysis was to investigate the combined and separate LDL-C-lowering effects of plant sterols and stanols at intakes up to on average 3 g/d when classified into different dose ranges. Studies with doses exceeding 4 g/d were not included as these are scarce.
Hypothesis: Comparable efficacy between plant sterols and stanols.
Methods: Studies were searched in several databases and selected based on predefined selection criteria. Studies were classified into different dose ranges for investigating the dose-response relationship; this approach was chosen as it was judged being more robust in controlling for any over- or underestimation of the estimated effects at certain doses which is a potential limiting factor in continuous dose-response analysis. For each of the dose ranges, a pooled LDL-C-lowering effect was calculated according to a random effects model while weighting the studies by the number of subjects. This was done for plant sterols and stanols combined and separately.
Results: In total, 119 studies (193 study arms) were included. Plant sterols and stanols were administered in 124 and 57 study arms, respectively; the remaining arms used a mix of both. The number of subjects per study was on average 49 (range: 7-201). The average dose of phytosterols was 1.9 g/d (range: 0.2-3.8 g/d). Phytosterol intakes of 1.5-3.0 g/d reduced LDL-C concentrations by on average 7-12%. When plant sterols and stanols were analysed separately, clear and comparable dose-response relationships for intakes up to 3 g/d were observed (Figure 1).
Conclusions: The LDL-C-lowering effect of phytosterols continues to increase up to intakes of 3 g/d to an average effect of -12%. This was shown for both plant sterols and stanols demonstrating comparable efficacy.
- © 2013 by American Heart Association, Inc.