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Foods enriched with phytosterols or phytostanols:
no place in cardiovascular prevention

People concerned about cardiovascular prevention would do better to follow a Mediterranean diet than to eat foods enriched with phytosterols.

Phytosterols, which have structure similar to that of cholesterol, are present in some vegetable oils. They are supposed to reduce the intestinal absorption of cholesterol, which has prompted some manufacturers to add them to foods. Several trials have evaluated whether foods heavily enriched with phytosterols lower blood levels of LDL cholesterol. The addition of 2g a day of these sterols very moderately reduces LDL cholesterol levels (by 6 to 10%), among both the general population and patients with relatively high cholesterol levels, whether they are undergoing treatment or not. There is no proof of a drop in the number of fatalities or of cardiovascular events with these products. The long-term effect of phytosterols has not been evaluated, and there have been few studies of their adverse effects or their possible interactions with drugs. Phytosterols reduce the absorption of some vitamins, and they should be avoided by pregnant women and young children. People concerned with cardiovascular prevention would do better to concentrate on eating a Mediterranean diet rich in vegetables and cereals and low in meat. In patients with a high cardiovascular risk, this diet can be combined, if necessary, with taking a thoroughly evaluated statin such as simvastatine.

©Prescrire November 2005

Source: "Aliments enrichis en phytostérols et phytostanols : petite baisse de la LDL-cholestérolémie, mais aucune évaluation clinique à long terme" Rev Prescrire 2005 ; 25 (266) : 763-768.

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