Is er een plaats voor voedingsmiddelen verrijkt met fytosterolen bij cardiovasculair risicomanagement? Kritische analyse van de bewijskracht voor cholesterolverlaging

Is there a place for phytosterol-enriched food products in cardiovascular risk management? Critical analysis of the evidence for cholesterol reduction OBJECTIVE To analyse the literature of the past decade regarding the cholesterol-lowering effect of phytosterol-enriched food products. DESIGN A literature study over a 10-year period, 2006-2016. METHODS PubMed was searched, using MeSH terms and free search terms, for studies on the effect of phytosterol-enriched food products on serum cholesterol levels and on the additive effect of such products on the lipid-lowering effect of statins. Only randomized placebo-controlled clinical studies, published between January 2006 and May 2016 were included. Total cholesterol (TC) and LDL cholesterol were considered as outcome measures. RESULTS In total, 32 studies fulfilled the inclusion criteria. Most studies showed a significant reduction of TC and LDL cholesterol blood levels after a daily intake of phytosterolenriched functional foods. Most studies were short, covering a period of about four weeks, and performed in relatively healthy populations. The optimal daily dose was 2-2.5 g of phytosterols. A daily dose of > 3 g did not result in an extra cholesterol-lowering effect. Combined with statins, phytosterol-containing functional foods may have an additional effect. CONCLUSION Despite the positive effect of phytosterol-enriched food products in hypercholesteraemic patients as reported in various studies, inclusion of these food products in the guidelines for cardiovascular risk management is not yet justified. From the studies performed so far, no evidence was obtained on long-term effects or on the effect on cardiovascular morbidity and mortality. These issues are still to be addressed.