Esteroles vegetales para adultos con hipercolesterolemia tratada con o sin fármacos (estatinas)

Raquel Bernácer, Diana Roig, Blanca Lozano

Resumen


La hipercolesterolemia es el factor de riesgo cardiovascular más frecuente en la población española. El 37,4% de la población adulta española presenta niveles de colesterol de entre 190 y 240 mg/dl. Los alimentos enriquecidos con esteroles vegetales (EV) pueden disminuir de forma efectiva el colesterol plasmático en pacientes con niveles elevados, sin embargo su efecto y seguridad en adultos con hipercolesterolemia moderada, tratados o no con fármacos (estatinas) ha sido menos estudiada. El objetivo de la presente revisión es establecer el posible papel de los esteroles vegetales en el control de la hipercolesterolemia, así como su seguridad en personas con hipercolesterolemia moderada tratada con estatinas. Se revisaron los principales estudios, sin limitación de diseño, lengua o fecha de publicación que relacionara “esteroles vegetales” e “hipercolesterolemia”, explotando las bases de datos Pubmed/Medline, SCOPUS y Google Scholar. Los estudios recuperados en la presente revisión muestran que el aporte de entre 2 y 3g/día de esteroles vegetales disminuyen de forma efectiva los niveles de colesterol plasmático en pacientes con hipercolesterolemia. Tanto los estudios clínicos como los metaanálisis disponibles no muestran problemas relacionados con la interacción fármaco-nutriente asociada al uso de alimentos enriquecidos con EV. En pacientes con hipercolesterolemia moderada en que no esté justificado el uso de estatinas, una alimentación saludable, actividad física y alimentos con EV, puede constituir el mejor acercamiento terapéutico.


Palabras clave


Hipercolesterolemia; Fitoesteroles; Esteroles Vegetales; Alimento Funcional; Inhibidores de Hidroximetilglutaril-CoA Reductasa; Estatinas

Texto completo:

PDF (English) HTML (English)

Referencias


(1) Royo Bordonada MÁ, Lobos Bejarano JM, Millán Núñez–Cortés J, Villar Álvarez F, Brotons Cuixart C, Camafort Babkowski M, et al. Dislipidemias: un reto pendiente en prevención cardiovascular. Documento de consenso CEIPC/SEA. Med Clin (Barc). 2011; 137(1): 30.e1–30.e13.

(2) Roth GA, Fihn SD, Mokdad AH, Aekplakorn W, Hasegawa T, Lim SS. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. Bull World Health Organ. 2011; 89(2): 92–101.

(3) Guallar–Castillón P, Gil–Montero M, León–Muñoz LM, Graciani A, Bayán–Bravo A, Taboada JM, et al. Magnitude and management of hypercholesterolemia in the adult population of Spain, 2008–2010: The ENRICA Study. Rev Esp Cardiol (Engl Ed). 2012; 65(6): 551–8.

(4) Gabriel R, Alonso M, Segura A, Tormo MJ, Artigao LM, Banegas JR, et al. Prevalence, geographic distribution and geographic variability of major cardiovascular risk factors in Spain. Pooled analysis of data from population–based epidemiological studies: the ERICE Study. Rev Esp Cardiol. 2008; 61(10): 1030– 40.

(5) Institut Català de la Salut. Hipercolesterolèmia. Guies de pràctica clínica i material docent. Barcelona. Institut Català de la Salut; 2001.

(6) National Cholesterol Education Program (NCEP): Third report of the NCEP Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Heart Lung and Blood Institute. 2002. En línea: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm [Consulta: 22 de enero de 2013].

(7) Fifth Joint Task Force of the European Society of Cardiology, European Association of Echocardiography, European Association of Percutaneous Cardiovascular Interventions, European Heart Rhythm Association, Heart Failure Association, European Association for Cardiovascular Prevention & Rehabilitation, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur J Prev Cardiol. 2012; 19(4): 585–667.

(8) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001; 285(19): 2486–97.

(9) Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al. Efficacy and safety of cholesterol–lowering treatment: prospective meta–analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005; 366(9493): 1267–78.

(10) Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D, Menotti A, Aravanis C, et al. Serum total cholesterol and longterm coronary heart disease mortality in different cultures. Twenty–five–year follow–up of the seven countries study. JAMA. 1995; 274(2): 131–6.

(11) Baena–Díez JM, Grau M, Sánchez–Pérez R, Altes–Vaques E, Salas–Gaetjens LH, Hernández–Ibáñez MR. The REGICORcalibrated function provides a better classification of high–risk patients on statin treatment in the Spanish population than the Framingham or SCORE classifications. Rev Esp Cardiol. 2009; 62(10): 1134–40.

(12) Haute Autorité de Santé. Pour un bon usage des statines. 2013. En línea: http://www.has-sante.fr/portail/jcms/c_1360516/pour-un-bon-usage-des-statines [Consulta: 22 de enero de 2013].

(13) Devaraj S, Jialal I. The role of dietary supplementation with plant sterols and stanols in the prevention of cardiovascular disease. Nutr Rev. 2006; 64(7 Pt 1): 348–54.

(14) MeSH. Medical Subject Headings. National Library of Medicine, (Bethesda, MD). Plant Sterols. 2012 En línea: http://www.ncbi.nlm.nih.gov/mesh?term=plant%20sterols [Consulta: 22 de enero de 2013].

(15) Talati R, Sobieraj DM, Makanji SS, Phung OJ, Coleman CI. The comparative efficacy of plant sterols and stanols on serum lipids: a systematic review and meta–analysis. J Am Diet Assoc. 2010; 110(5): 719–26.

(16) Calpe–Berdiel L, Escolà–Gil JC, Blanco–Vaca F. New insights into the molecular actions of plant sterols and stanols in cholesterol metabolism. Atherosclerosis. 2009; 203(1): 18–31.

(17) Chan Y–M, Varady KA, Lin Y, Trautwein E, Mensink RP, Plat J, et al. Plasma concentrations of plant sterols: physiology and relationship with coronary heart disease. Nutr Rev. 2006; 64(9): 385–402.

(18) Jones PJ, Raeini–Sarjaz M, Ntanios FY, Vanstone CA, Feng JY, Parsons WE. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res. 2000; 41(5): 697–705.

(19) Rincón–León F. Functional foods, En: Caballero B (Editor). Encyclopedia of Food Sciences and Nutrition. 2a ed. Oxford: Academic Press; 2003. p. 2827–2832.

(20) Jiménez–Escrig A, Santos–Hidalgo AB, Saura–Calixto F. Common sources and estimated intake of plant sterols in the Spanish diet. J Agric Food Chem. 2006; 54(9): 3462–71.

(21) Palou A, Picó C, Bonet ML, Oliver P, Serra F, Rodríguez AM, Ribot J. El libro blanco de los EV en alimentación. 2a Ed. Barcelona: Innuo S.L–Instituto Flora–Unilever Foods S.A.; 2005.

(22) Law M. Plant sterol and stanol margarines and health. BMJ. 2000; 320(7238): 861–4.

(23) Wu T, Fu J, Yang Y, Zhang L, Han J. The effects of phytosterols/ stanols on blood lipid profiles: a systematic review with metaanalysis. Asia Pac J Clin Nutr. 2009; 18(2): 179–86.

(24) Moruisi KG, Oosthuizen W, Opperman AM. Phytosterols/ stanols lower cholesterol concentrations in familial hypercholesterolemic subjects: a systematic review with metaanalysis. J Am Coll Nutr. 2006; 25(1): 41–8.

(25) Baker WL, Baker EL, Coleman CI. The effect of plant sterols or stanols on lipid parameters in patients with type 2 diabetes: a meta–analysis. Diabetes Res Clin Pract. 2009; 84(2): e33–7.

(26) Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R, et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc Mayo Clin. 2003; 78(8): 965–78.

(27) EFSA. European Food Safety Authority. Scientific substantiation of a health claim related to plant sterols and lower/reduced blood cholesterol and reduced risk of (coronary) heart disease pursuant to Article 14 of Regulation (EC) No 1924/2006. The EFSA Journal. 2008; 781: 1–12.

(28) EFSA. European Food Safety Authority. Scientific substantiation of a health claim related to a low fat fermented milk product (Danacol®) enriched with plant sterols/stanols and lowering/ reducing blood cholesterol and reduced risk of (coronary) heart disease pursuant to Article 14 of Regulation (EC) No 1924/2006. The EFSA Journal 2009; 1177: 1–12.

(29) EFSA. European Food Safety Authority. Plant Stanols and Plant Sterols and Blood LDL–Cholesterol. EFSA Journal. 2009; 1175: 2–9.

(30) EFSA. European Food Safety Authority. Plant sterols/plant stanols related health claims. EFSA Journal. 2010; 8(10): 1813.

(31) American Diabetes Association. Standards of medical care in diabetes–2011. Diabetes Care. 2011; 34 Suppl 1: S11–61.

(32) Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012; 33(13): 1635–701.

(33) Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WMM, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis. 2012; 223(1): 1–68.

(34) Ras RT, Geleijnse JM, Trautwein EA. LDL–cholesterol–lowering effect of plant sterols and stanols across different dose ranges: a meta–analysis of randomised controlled studies. Br J Nutr. 2014; 112(2): 214–9.

(35) Musa–Veloso K, Poon TH, Elliot JA, Chung C. A comparison of the LDL–cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: results of a meta–analysis of randomized, placebo–controlled trials. Prostaglandins Leukot Essent Fatty Acids. 2011; 85(1): 9–28.

(36) Gupta AK, Savopoulos CG, Ahuja J, Hatzitolios AI. Role of phytosterols in lipid–lowering: current perspectives. QJM. 2011; 104(4): 301–8.

(37) Malinowski JM, Gehret MM. Phytosterols for dyslipidemia. Am J Health Syst Pharm. 2010; 67(14): 1165–73.

(38) González–Larena M, García–Llatas G, Vidal MC, Sánchez– Siles LM, Barberá R, Lagarda MJ. Stability of plant sterols in ingredients used in functional foods. J Agric Food Chem. 2011; 59(8): 3624–31.

(39) Sudhop T, Gottwald BM, von Bergmann K. Serum plant sterols as a potential risk factor for coronary heart disease. Metabolism. 2002; 51(12): 1519–21.

(40) Escurriol V, Cofán M, Moreno–Iribas C, Larrañaga N, Martínez C, Navarro C, et al. Phytosterol plasma concentrations and coronary heart disease in the prospective Spanish EPIC cohort. J Lipid Res. 2010; 51(3): 618–24.

(41) Genser B, Silbernagel G, De Backer G, Bruckert E, Carmena R, Chapman MJ, et al. Plant sterols and cardiovascular disease: a systematic review and meta–analysis. Eur Heart J. 2012; 33(4): 444–51.

(42) European Commission. Opinion on a request for the safety assessment of the use of phytosterol esters in yellow fat spreads. Scientific Committee on Food. 2000. En línea: http://ec.europa.eu/food/fs/sc/scf/out56_en.pdf [Consulta: 22 de enero de 2013].

(43) Myrie SB, Mymin D, Triggs–Raine B, Jones PJH. Serum lipids, plant sterols, and cholesterol kinetic responses to plant sterol supplementation in phytosterolemia heterozygotes and control individuals. Am J Clin Nutr. 2012; 95(4): 837–44.

(44) European Commission. General view on the long–term effects of the intake of elevated levels of phytosterols from multiple dietary sources, with particular attention to the effects on β–carotene. Scientific Committee on Food. 2002. En línea: http://ec.europa.eu/food/fs/sc/scf/out143_en.pdf [Consulta: 22 de enero de 2013].

(45) European Commission. Opinion of the Scientific Committee on Food on an application from MultiBene for approval of plantsterol enriched foods. Scientific Committee on Food. 2003. En línea: http://ec.europa.eu/food/fs/sc/scf/out191_en.pdf [Consulta: 22 de enero de 2013].

(46) Cholesterol Treatment Trialists' (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta–analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010; 376(9753): 1670–81.

(47) Chan DKY, O'Rourke F, Shen Q, Mak JCS, Hung WT. Metaanalysis of the cardiovascular benefits of intensive lipid lowering with statins. Acta Neurol Scand. 2011; 124(3): 188– 95.

(48) Weng T–C, Yang Y–HK, Lin S–J, Tai S–H. A systematic review and meta–analysis on the therapeutic equivalence of statins. J Clin Pharm Ther. 2010; 35(2): 139–51.

(49) Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd– Jones DM, Blum CB, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63(25 Pt B): 2889–934.

(50) Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS), Catapano AL, Reiner Z, De Backer G, Graham I, Taskinen M–R, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. 2011; 217 Suppl 1: S1–44.

(51) Taylor F, Huffman MD, Macedo AF, Moore THM, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013; 1: CD004816.

(52) González–Juanatey JR, Millán J, Alegría E, Guijarro C, Lozano JV, Vitale GC. Prevalencia y características de la dislipemia en pacientes en prevención primaria y secundaria tratados con estatinas en España. Estudio DYSIS–España. Rev Esp Cardiol. 2011; 64(4): 286–94.

(53) Jenkins DJA, Kendall CWC, Nguyen TH, Marchie A, Faulkner DA, Ireland C, et al. Effect of plant sterols in combination with other cholesterol–lowering foods. Metabolism. 2008; 57(1): 130–9.

(54) Scholle JM, Baker WL, Talati R, Coleman CI. The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: systematic review and metaanalysis. J Am Coll Nutr. 2009; 28(5): 517–24.

(55) American Heart Association. Phytochemicals and Cardiovascular Disease. 2013. En línea: http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Phytochemicals–and–Cardiovascular–Disease_UCM_306020_Article.jsp [Consulta: 22 de enero de 2013].

(56) Alberton M, Wu P, Druyts E, Briel M, Mills EJ. Adverse events associated with individual statin treatments for cardiovascular disease: an indirect comparison meta–analysis. QJM Mon J Assoc Physicians. 2012; 105(2): 145–57.

(57) Grundy SM. Stanol esters as a component of maximal dietary therapy in the National Cholesterol Education Program Adult Treatment Panel III report. Am J Cardiol. 2005; 96(1A): 47D – 50D.

(58) Perisee DM. Food fortification with plant sterol/stanol for hyperlipidemia: Management in free–living populations. J Am Diet Assoc. 2005; 105(1): 52–3.

(59) Reynolds TM, Mardani A, Twomey PJ, Wierzbicki AS. Targeted versus global approaches to the management of hypercholesterolaemia. J R Soc Promot Health. 2008; 128(5): 248–54.

(60) Jenkins DJA, Jones PJH, Lamarche B, Kendall CWC, Faulkner D, Cermakova L, et al. Effect of a dietary portfolio of cholesterollowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. JAMA. 2011; 306(8): 831–9.

(61) European Commission. EU Register on nutrition and health claims. 2012. En línea: http://ec.europa.eu/nuhclaims/?event=searchformReset=1 [Consulta: 22 de enero de 2013].

(62) Reglamento (CE) no 983/2009 de la Comisión, de 21 de octubre de 2009, sobre la autorización o la denegación de autorización de determinadas declaraciones de propiedades saludables en los alimentos relativas a la reducción del riesgo de enfermedad y al desarrollo y la salud de los niños. Diario Oficial de la Unión Europea (DOUE), núm. 277, de 22/10/2009, páginas 3 a 12.

(63) Reglamento (UE) no 376/2010 de la Comisión, de 3 de mayo de 2010, por el que se modifica el Reglamento (CE) no 983/2009, sobre la autorización o la denegación de autorización de determinadas declaraciones de propiedades saludables en los alimentos relativas a la reducción del riesgo de enfermedad y al desarrollo y la salud de los niños. Diario Oficial de la Unión Europea (DOUE), núm. 111, de 4/05/2010, páginas 3 a 4.

(64) Reglamento (UE) no 384/2010 de la Comisión, de 5 de mayo de 2010, sobre la autorización o denegación de autorización de determinadas declaraciones de propiedades saludables en los alimentos relativas a la reducción del riesgo de enfermedad y al desarrollo y la salud de los niños. Diario Oficial de la Unión Europea (DOUE), núm. 113, de 6/05/2010, páginas 6 a 10.

(65) EFSA European Food Safety Authority. Scientific Opinion on the substantiation of a health claim related to 3 g/day plant sterols/stanols and lowering blood LDL–cholesterol and reduced risk of (coronary) heart disease pursuant to Article 19 of Regulation (EC) No 1924/2006. EFSA Journal. 2012; 10(5): 2693.

(66) Poli A, Marangoni F, Paoletti R, Mannarino E, Lupattelli G, Notarbartolo A, et al. Non–pharmacological control of plasma cholesterol levels. Nutr Metab Cardiovasc Dis. 2008; 18(2): S1–16.




DOI: http://dx.doi.org/10.14306/renhyd.0.0.64

Enlaces refback

  • No hay ningún enlace refback.




Copyright (c)



  

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional.

Esta revista ha conseguido la validación para ser Data Provider OAI-PMH version 2.0 de Open Archives Initiative (OAI)



ISSN (online): 2174-5145 / ISSN (print): 2173-1292

Abreviatura: Rev Esp Nutr Hum Diet

DOI revista: 10.14306/renhyd

 

 

Facebook: https://www.facebook.com/renhyd

 

Twitter: https://twitter.com/renhyd_org (@renhyd_org)

 

 

Indexada en:

 

 

 

 

Cooperación entre revistas iberoamericanas de nutrición humana:

Perspectivas en Nutrición Humana

 

 

¿Quién nos visita?