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Plant sterols lower LDL cholesterol without improving endothelial function in prepubertal children with familial
S de Jongh1, M N Vissers, P Rol
1Department of Vascular Medicine, Academic Medical Center Amsterdam, The Netherlands. s.dejongh@amc.uva.nl
Insights
Plant sterols effectively lower LDL cholesterol in children with familial hypercholesterolaemia (FH). However, this short-term treatment did not improve their endothelial function, a key indicator of early artery disease.
Area of Science:
- Cardiovascular Research
- Pediatric Endocrinology
- Nutritional Science
Background:
- Familial hypercholesterolaemia (FH) presents a significant risk for early atherogenesis.
- Limited therapeutic options exist for managing high cholesterol in children with FH.
- Plant sterols are known to reduce cholesterol by inhibiting absorption.
Purpose of the Study:
- To assess the impact of plant sterols on cholesterol levels and vascular function in prepubertal children with FH.
- To compare endothelial function in FH children with healthy controls.
Main Methods:
- A double-blind crossover trial involving 41 FH children (5-12 years) treated with plant sterol spreads (2.3g/day) or placebo for 4 weeks.
- Assessment of lipid levels and flow-mediated dilation (FMD) of the brachial artery.
- Comparison of FH children's data with 20 healthy controls.
Main Results:
- Plant sterol intake significantly reduced total cholesterol (-11%) and LDL cholesterol (-14%) compared to placebo.
- FH children on placebo exhibited impaired FMD (7.2%) versus healthy controls (10.1%).
- LDL cholesterol reduction via plant sterols did not improve FMD in FH children (7.2% vs 7.7%).
Conclusions:
- Plant sterol treatment effectively lowers LDL cholesterol in prepubertal children with FH.
- Short-term plant sterol supplementation does not enhance endothelial function in this pediatric population.
Abstract:
In adults with familial hypercholesterolaemia (FH), cholesterol lowering with statins has been shown to improve the endothelial function, a hallmark of early atherogenesis. Currently, therapeutic options for treating high cholesterol levels in FH children are limited. Plant sterols safely and effectively reduce serum cholesterol concentrations by inhibiting cholesterol absorption. Therefore, we evaluated the effect of plant sterols on cholesterol and vascular function in prepubertal children with FH. We included 41 children (5-12 years old) with FH in a double-blind crossover trial using spreads containing 2.3 g of plant sterols (mainly sitosterol and campesterol) per 15 g spread and a placebo spread for a 4-week period, separated by a 6-week washout period. Lipid levels and endothelial function were assessed after both 4-week treatment periods. Endothelial function was assessed as flow-mediated dilation (FMD) of the brachial artery using a wall tracking system. Data were compared to those of 20 healthy controls. Intake of 2.3 g plant sterols per day decreased total cholesterol (-11%) and low-density cholesterol (-14%) as compared to placebo spread in FH children. FH children treated with placebo spread were characterized by an impaired FMD compared to healthy control children (7.2% +/- 3.4% versus 10.1% +/- 4.2%, p < 0.005). However, the reduction of LDL in FH children did not improve FMD (placebo: 7.2% +/- 3.4% versus plant sterols: 7.7% +/- 4.1%). In conclusion, the present study shows a clear reduction of LDL cholesterol by plant sterol treatment. However, short-term plant sterol treatment does not improve the endothelial function in FH children.