Phytosterol consumption and markers of subclinical atherosclerosis: Cross-sectional results from ELSA-Brasil

Nutr Metab Cardiovasc Dis. 2021 Jun 7;31(6):1756-1766. doi: 10.1016/j.numecd.2021.02.031. Epub 2021 Mar 20.


Background and aims: Phytosterol (PS) consumption is associated with lower total and LDL-cholesterol (LDL-c) concentrations, but its impact on cardiovascular risk is unclear. This study assessed the effect of usual intake of PS on markers of subclinical atherosclerosis in the Longitudinal Study of Adult Health (ELSA-Brasil).

Methods and results: This cross-sectional study included 2560 participants of ELSA-Brasil, aged 48 (43-54) years, with available food frequency questionnaires (FFQ), coronary artery calcium (CAC) scores, carotid intima media thickness (cIMT), and carotid-femoral pulse wave velocity (cf-PWV), at baseline. Several logistic and linear regression models were used, and significance level was set at a P < 0.05. Mean values (SD) for PS consumption were 256 (198) mg/day, CAC 22.78 (110.54) Agatston Units, cf-PWV 9.07 (1.60) m/s and cIMT 0.57 (0.12) mm. PS consumption in Q4 was associated with lower total- and LDL-c levels, and with higher percentiles of cf-PWV (P < 0.001). Proportion of subjects in Q4 of PS consumption was 1.5 times higher among individuals in cf-PWV Q4, than in Q1 (P = 0.002, for comparisons among quartiles). There was a trend (P = 0.003) for higher cf-PWV with higher PS intake. In crude logistic and linear regressions, PS intake was associated with cf-PWV. In the adjusted models, these associations disappeared. No associations were found between PS and cIMT or CAC.

Conclusions: In this large and apparently healthy cross-sectional sample from ELSA-Brasil, usual PS consumption was associated with lower total- and LDL-cholesterol, but not with markers of subclinical atherosclerosis.

Keywords: Atherosclerosis; Carotid intima media thickness; Coronary calcium score; Diet; Lipids; Phytosterols; Pulse-wave velocity.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / blood
  • Brazil / epidemiology
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / epidemiology*
  • Carotid Artery Diseases / prevention & control
  • Carotid Intima-Media Thickness
  • Carotid-Femoral Pulse Wave Velocity
  • Cholesterol, LDL / blood
  • Coronary Angiography
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology*
  • Coronary Artery Disease / prevention & control
  • Cross-Sectional Studies
  • Diet* / adverse effects
  • Feeding Behavior
  • Female
  • Humans
  • Male
  • Middle Aged
  • Phytosterols / administration & dosage*
  • Phytosterols / adverse effects
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Factors
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / epidemiology*
  • Vascular Calcification / prevention & control
  • Vascular Stiffness


  • Biomarkers
  • Cholesterol, LDL
  • Phytosterols