The impact of increased serum concentrations of plant sterols on cardiovascular risk is unclear. We conducted a systematic review and meta-analysis aimed to investigate whether there is an association between serum concentrations of two common plant sterols (sitosterol, campesterol) and cardiovascular disease (CVD). We systematically searched the databases MEDLINE, EMBASE, and COCHRANE for studies published between January 1950 and April 2010 that reported either risk ratios (RR) of CVD in relation to serum sterol concentrations (either absolute or expressed as ratios relative to total cholesterol) or serum sterol concentrations in CVD cases and controls separately. We conducted two meta-analyses, one based on RR of CVD contrasting the upper vs. the lower third of the sterol distribution, and another based on standardized mean differences between CVD cases and controls. Summary estimates were derived by fixed and random effects meta-analysis techniques. We identified 17 studies using different designs (four case–control, five nested case–control, three cohort, five cross-sectional) involving 11 182 participants. Eight studies reported RR of CVD and 15 studies reported serum concentrations in CVD cases and controls. Funnel plots showed evidence for publication bias indicating small unpublished studies with non-significant findings. Neither of our meta-analyses suggested any relationship between serum concentrations of sitosterol and campesterol (both absolute concentrations and ratios to cholesterol) and risk of CVD. Our systematic review and meta-analysis did not reveal any evidence of an association between serum concentrations of plant sterols and risk of CVD.

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Plant sterols and cardiovascular disease: a systematic review and meta-analysis.

Plant-based sterols and stanols in health & disease: "Consequences of human development in a plant-based environment?"

Implementing Phytosterols Into Medical Practice as a Cholesterol-Lowering Strategy: Overview of Efficacy, Effectiveness, and Safety

Serum plant and other noncholesterol sterols, cholesterol metabolism and 22-year mortality among middle-aged men.

Relationship between cholesterol synthesis and intestinal absorption is associated with cardiovascular risk

ObjectiveHypercholesterolemia is a risk factor for aortic stenosis (AS) and for coronary artery disease (CAD). Serum cholesterol concentrations are determined by intestinal cholesterol absorption and endogenous cholesterol synthesis. Vascular effects of differences in cholesterol metabolism in patie

Alterations in cholesterol homeostasis are associated with coronary heart disease in patients with aortic stenosis.

Angiotensin-converting enzyme (ACE) inhibitor treatment was started in a 67-year-old woman with arterial hypertension Two days later she complained of a hoarse, raspy voice and progressive abdominal pain The laboratory investigation was within normal limits However, CT scans of the abdomen revealed marked thickening of the proximal jejunum together with substantial fluid accumulation in the abdomen and pelvis Due to the severity of the symptoms diagnostic laparatomy was considered as a surgical option Several hours later the patient started to complain about a progressive inspiratory stridor, which resolved after treatment with epinephrine, antihistamines and corticosteroids ACE inhibitor induced angioedema was suspected and ACE inhibitor treatment was stopped, after which the severe abdominal symptoms also resolved completely ACE inhibitor induced angioedema is a rare and often unrecognised side effect of ACE inhibitor treatment that physicians need to be aware of in order to avoid unnecessary invasive procedures, including explorative laparatomy

Nadja Weingärtner

Papers

Alterations in cholesterol homeostasis are associated with coronary heart disease in patients with aortic stenosis.

Bad gut feeling: ACE inhibitor induced intestinal angioedema.