Effects of phytosterol ester-enriched margarine on plasma lipoproteins in mild to moderate hypercholesterolemia are related to basal cholesterol and fat intake

Dietary phytosterols have been reported to lower total and low-density lipoprotein (LDL) cholesterol. However, less is known about the influence of cholesterol and fat intake on the cholesterol-lowering effect of esterified phytosterols in mild to moderate hypercholesterolemia. Sixty-three healthy subjects (38 women, 25 men, 42 +/- 11 years, LDL cholesterol > 130 mg/dL) were investigated in a randomized, double-blind, placebo-controlled, cross-over study. A total of 20 g/d of a phytosterol ester-enriched margarine (1.82 g/d of phytosterols) was compared with a control margarine (0.06 g/d of phytosterols). After 3 weeks of intake, participants crossed over to the other margarine. A 3-day dietary recall was performed at the beginning and at the end of the study to assess cholesterol, fat, and energy intake. Phytosterol ester-enriched margarine significantly changed total cholesterol (-3.4%, P <.005), LDL cholesterol (-5.4%, P <.001, 144 +/- 28 v 154 +/- 26 mg/dL), high-density lipoprotein (HDL) cholesterol (+3.4%, P <.05), apolipoprotein B (-4.0%, P <.005), and LDL/HDL cholesterol ratio (-7.8%, P <.001) compared with the control margarine. In the tertiles with the highest dietary intake of cholesterol, energy, total fat, and saturated fatty acids, and with the highest baseline proportion of campesterol to cholesterol, LDL cholesterol reduction was 11.6% (P <.001), 9.5% (P =.001), 9.4% (P =.001), 8.4% (P =.005), and 6.2% (P =.014), respectively. Triglycerides, plasma viscosity, and fibrinogen concentration did not change significantly. The improvements of LDL, HDL, total cholesterol, apolipoprotein B concentrations, and LDL/HDL cholesterol ratio during the daily consumption of a phytosterol ester-enriched margarine were most marked in those subjects with a high dietary intake of cholesterol, energy, total fat, and saturated fatty acids and with high baseline cholesterol absorption.