Les phytostérols et les phytostanols: quelle place pour la prévention cardiovasculaire?

Phytosterols are natural plant compounds. Phytostanols are derived from phytosterols’ hydrogenation. Both they inhibit intestinal dietary cholesterol absorption by competition, and they decrease LDL cholesterol by 8-15%, in a dose-dependant manner. They impair carotenoids bioavailability. A very small and variable part of phytosterols and phytostanols is absorbed. No epidemiological data is available for assessing the beneficial of plant sterols intake and cardiovascular risk. In the other hand there are many studies which have shown paradoxically a positive relationship between serum phytosterols concentrations and increase of the coronary heart disease risk. Other studies have established a link between the phytosterols’ absorption and their plasma and arterial plaque levels. Phytosterols and cholesterol hyperabsorbers subjects would be particularly involved in this unfavourable issue. Phytostanols could have a different effect from that point of view. In animal studies, data are less inconsistent with, in most of the studies, a lesser progression of atheroma lesions, perhaps due to an anti-inflammatory effect of phytosterols in atheroma plaque. The place of phytosterols and phytostanols in the therapeutic step for cardiovascular prevention is actually not defined. Many queries are still open. Complementary studies are needed for improving the clinical indications and the efficiency of these compounds.