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Review
, 33 (4), 444-51

Plant Sterols and Cardiovascular Disease: A Systematic Review and Meta-Analysis

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Review

Plant Sterols and Cardiovascular Disease: A Systematic Review and Meta-Analysis

Bernd Genser et al. Eur Heart J.

Abstract

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 Funnel plots showed evidence for publication bias indicating small unpublished studies with non-significant findings.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.

Figures

Figure 1
Figure 1
Conceptual model: plant sterols and cardiovascular disease.
Figure 2
Figure 2
Identification process for eligible studies.
Figure 3
Figure 3
Serum levels of campesterol and risk of cardiovascular disease (A: absolute concentrations, B: ratios to total cholesterol). D + L: DerSimonian & Laird random effects estimate; I-V: inverse variance fixed effects estimate; diamonds: point estimate and 95% confidence interval; boxes: size proportional to study weight for random effects approach; black line: reference line indicating the absence of effect; blue line: point estimate of random effects approach.
Figure 4
Figure 4
Serum levels of campesterol in CVD cases and controls (A: absolute concentrations, B: ratios to total cholesterol). D + L: DerSimonian & Laird random effects estimate; I-V: inverse variance fixed effects estimate; diamonds: point estimate and 95% confidence interval; boxes: size proportional to study weight for random effects approach; black line: reference line indicating absence of effect; blue line: point estimate of random effects approach.
Figure 5
Figure 5
Serum levels of sitosterol and risk of cardiovascular disease (A: absolute concentrations, B: ratios to total cholesterol). D + L: DerSimonian & Laird random effects estimate; I-V: inverse variance fixed effects estimate; diamonds: point estimate and 95% confidence interval; boxes: size proportional to study weight for random effects approach; black line: reference line indicating absence of effect; blue line: point estimate of random effects approach.
Figure 6
Figure 6
Serum levels of sitosterol in CVD cases and controls (A: absolute concentrations, B: ratios to total cholesterol). D + L: DerSimonian & Laird random effects estimate; I-V: inverse variance fixed effects estimate; diamonds: point estimate and 95% confidence interval; boxes: size proportional to study weight for random effects approach; black line: reference line indicating absence of effect; blue line: point estimate of random effects approach.

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