Plant sterols: Nutritional aspects

With repeated demonstration of effective low-density lipoprotein cholesterol reductions, plant sterols should comprise a central aspect of future worldwide sustainable healthcare systems that will require readily accessible and effective strategies to prevent dyslipidemia and associated arterial health conditions. Clinical studies suggest that plant sterol consumption is associated with circulatory LDL-cholesterol reductions in the range of 10%. The clinical trial database suggests that cholesterol reductions in response to plant sterol therapy are variable. This heterogeneity of responsiveness in response to plant sterols is related to both study design and subject-specific factors. In general, greater cholesterol reductions are observed in hyper-cholesterolemic subjects consuming two to three servings per day of plant sterol-fortified fat spreads, salad dressing, milk, and yogurt compared with normal cholesterolemic subjects consuming plant sterol-enriched muffins or low-fat products as a single morning dose. Metabolic factors including basal rate of cholesterol synthesis and genetic factors including single nucleotide polymorphisms in genes that regulate plant sterol and cholesterol homeostasis likely underlie much of the variable LDL-C reduction potential of plant sterols. The cardioprotective effects of plant sterols may be further realized in combination with other lipid-lowering dietary and pharmacological therapies.