Author + information
- Received June 22, 2007
- Revision received August 29, 2007
- Accepted September 10, 2007
- Published online April 22, 2008.
- Oliver Weingärtner, MD⁎,
- Dieter Lütjohann, PhD‡,
- Shengbo Ji∥,
- Nicole Weisshoff⁎,
- Franka List⁎,
- Thomas Sudhop, MD§,
- Klaus von Bergmann, MD§,
- Karen Gertz, MD∥,
- Jochem König, PhD¶,
- Hans-Joachim Schäfers, MD†,
- Matthias Endres, MD∥,
- Michael Böhm, MD⁎ and
- Ulrich Laufs, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Ulrich Laufs, Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421 Homburg/Saar, Germany.
Objectives The purpose of this study was to evaluate vascular effects of diet supplementation with plant sterol esters (PSE).
Background Plant sterol esters are used as food supplements to reduce cholesterol levels. Their effects on endothelial function, stroke, or atherogenesis are not known.
Methods In mice, plasma sterol concentrations were correlated with endothelial function, cerebral lesion size, and atherosclerosis. Plasma and tissue sterol concentrations were measured by gas-liquid chromatography-mass spectrometry in 82 consecutive patients with aortic stenosis.
Results Compared with those fed with normal chow (NC), wild-type mice fed with NC supplemented with 2% PSE showed increased plant sterol but equal cholesterol plasma concentrations. The PSE supplementation impaired endothelium-dependent vasorelaxation and increased cerebral lesion size after middle cerebral artery occlusion. To test the effects of cholesterol-lowering by PSE, apolipoprotein E (ApoE)−/− mice were randomized to Western-type diet (WTD) with the addition of PSE or ezetimibe (EZE). Compared with WTD, both interventions reduced plaque sizes; however, WTD + PSE showed larger plaques compared with WTD + EZE (20.4 ± 2.1% vs. 10.0 ± 1.5%). Plant sterol plasma concentration strongly correlated with increased atherosclerotic lesion formation (r = 0.50). Furthermore, we examined plasma and aortic valve concentrations of plant sterol in 82 consecutive patients with aortic stenosis. Patients eating PSE-supplemented margarine (n = 10) showed increased plasma concentrations and 5-fold higher sterol concentrations in aortic valve tissue.
Conclusions Food supplementation with PSE impairs endothelial function, aggravates ischemic brain injury, effects atherogenesis in mice, and leads to increased tissue sterol concentrations in humans. Therefore, prospective studies are warranted that evaluate not only effects on cholesterol reduction, but also on clinical endpoints. (Concentration of Plant Sterols in Serum and Aortic Valve Cusps; NCT00222950)
This study was supported by the Deutsche Forschungsgemeinschaft, the University of the Saarland, the Adumed-Stiftung, the Volkswagen Stiftung, and a minor unrestricted research grant from Merck Sharp & Dohme to the University of the Saarland.
- Received June 22, 2007.
- Revision received August 29, 2007.
- Accepted September 10, 2007.
- American College of Cardiology Foundation