Возможности и эффекты применения эфиров растительных станолов в немедикаментозной профилактике сердечно-сосудистых заболеваний, обусловленных атеросклерозом

Действие пищевых продуктов, обогащенных эфирами растительных станолов (ЭРС), по снижению уровня общего холестерина (ОХС) и ХС наиболее атерогенных липопротеидов низкой плотности (ЛНП) обусловлено ингибированием абсорбции ХС энтероцитами из просвета кишечника. ЭРС тормозят абсорбцию как пищевого, так и билиарного ХС. Эстерифицированные ненасыщенными жирными кислотами станолы хорошо растворяются как в высокожировых продуктах (спреды), так и в низкожировых (молоко, кефир, йогурты и др.). Эффективно снижающими уровни ХС в плазме крови и ХС ЛНП дозами ЭРС являются дозы 1,6-2,8 г/сут.; степень снижения ОХС 7-10%, ХС ЛНП 12-15%. При использовании продуктов, обогащенных ЭРС у лиц с гиперхолестеринемией (ГХС) на фоне лечения ингибиторами синтеза ХС – статинами, степень снижения уровня ХС ЛНП увеличивается на 10-20%. «Функциональные» продукты, содержащие ЭРС, могут быть широко использованы для немедикаментозного лечения ГХС и для профилактики сердечно-сосудистых заболеваний среди широких слоев населения.

1. Fernandes – Britto JI, Wong R, Contreras D, et al. Pathomorphometrical characteristics of atherosclerosis in youth: a multinational investigation of WHO/World Health Federation (1986-1996), using atheromic system. Nutr Metab Cardiovasc Dis 1999; 9: 210-9.

2. Martin MJ, Hulley SB, Browner WS, et al. Serum cholesterol, blood pressure and mortality: implications from a cohort of 361,622 men. Lancet 1986; 11: 933-6.

3. Puska P. Succesful strategies to influence national diets: the Finnish experience. Zdrav Var 2003; 43: 191-6.

4. Grundy SM. United States Cholesterol Guidelines 2001: expanded scope of intensyve low-density-lipoprotein-lowering therapy. Am J Cardiol 2001; 88(Suppl 2): 23J-7.

5. 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): 47D50.

6. Altmann SW, Davis HR Jr, Zhu LJ. Niemann-Pick C1 Like 1 protein is critical for intestinal cholesterol absorption. Science 2004; 303(5661): 1201-4.

7. Plat J, Mensink P. Plant stanol and sterol esters in the control of blood cholesterol levels: mechanism and safety aspects. Am J Cardiol 2005; 96(1A): 15d-22.

8. Plat J, van Onselen EN, van Heugten MM, Mensink RP. Effects on serum lipids, lipoproteins and fat soluble antioxidant concentrations of consumption frequency of margarines and shortenings enriched with plant stanol esters. Eur J Clin Nutr 2000; 54(9): 671-7.

9. Igel M, Giesa U, Lutjohann D, von Bergmann K. Comparison of the intestinal uptake of cholesterol, plant sterols, and stanols in mice. J Lipid Res 2003; 44(3): 533-8.

10. Plat J, Mensink RP. Increased intestinal ABCA1 expression contributes to the decrease in cholesterol absorption after plant stanol consumption. FASEB J 2002; 16(10): 1248-53.

11. Plat J, Mensink RP. Relationship of genetic variation in genes encoding apolipoprotein A-IV, scavenger receptor BI, HMGCoA reductase, CETP and apolipoprotein E with cholesterol metabolism and the response to plant stanol ester consumption. Eur J Clin Invest 2002; 32(4): 242-50.

12. von Bergmann K, Sudhop T, Lutjohann D. Cholesterol and plant sterols absorption: resent insights. Am J Cardiol 2005; 96(1A): 10D.

13. Field FJ, Born E, Mathur SN. Stanol esters decrease plasma cholesterol independently of intestinal ABC sterol transporters and Niemann-Pick C1-like protein gene expression. J Lipid Res 2004; 45: 2252-9.

14. Sierksma A, Weststrate JA, Meijer GW. Spreds enriched with plant sterols, either esterified 4,4-dimethylsterols with plasma total and LDL-cholesterol concentrations. Br J Nutr 1999; 82: 273-82.

15. Wester I. Dose responsiveness to plant stanol esters. Eur Heart J 1999; (Suppl S): S104-8.

16. Miettinen TA, Puska P, Gylling H, et al. Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterinemic population. N Engl J Med 1995; 333: 1308-12.

17. Vanhanen HT, Blomquist S, Ehnholm C et al. Serum cholesterol, cholesterol precursors and plant sterols in hypercholesterolemic subjects with different apo E phenotypes during dietary sitostanol treatment. J Lipid Res 1993; 34: 1535-44.

18. Vanhanen HT, Hajander J, Lehtovirta H, Miettinen TA. Serum levels, absorbteon efficiecy, faecal elimination and synthesis of cholesterol during increasing doses of dietary sitostanol esters in chypercholesterolaemic subjects. Clin Sci (Lond.) 1994; 87: 61-7.

19. Miettinen TA, Vanhanen HT. Dietary sitostanol related to absorption, Synsesis and serum level of cholesterol in different apolipiprotein phenotypes. Atherosclerosis 1994;105: 217-26.

20. Thompson GR, Grundy SM. History and development of plant sterol and stanol esters for cholesterol-lowering purposes. Am J Cardiol 2005; (1A): 3D-9.

21. Gylling H, Rajaratnam RA, Vartiainen E, et al. Changes in serum level and metabolism of cholesterol with plant stanol esters in postmenopausal women with and without coronary artery disease. Menopause 2006; 13(2): 286-93.

22. Noakes M, Clifton PM, Doornbos AM, Trautwein EA. Plant sterol ester-enriched milk and yoghurt effectively reduce serum cholesterol in modestly hypercholesterolemic subjects. Eur J Nutr 2005; 44(4): 214-22.

23. Jauhiainen T, Salo P, Niittynen L, et al. Effects of low-fat hard cheese enriched with plant stanol esters on serum lipids and apolipoprotein B in mildly hypercholesterolaemic subjects. Eur J Clin Nutr 2006; [Epub ahead of print].

24. Ishiwata K, Homma Y, Ishikawa T et al. Influence of apolipoprotein E phenotype on metabolism of lipids and apolipoproteins after plant stanol ester ingestion in Japanese subjects. Nutrition 2002; 18(7-8): 561-5.

25. Luoto R, Simojoki M, Uutela A, et al. Consistency of use of plant stanol ester margarine in Finland. Public Health Nutr 2004; 7(1): 63-8.

26. Simojoki M, Luoto R, Uutela A, et al. Use of plant stanol ester margarine among persons with and without cardiovascular disease: early phases of the adoption of a functional food in Finland. Nutr J 2005; 4: 20-5.

27. Gylling H, Miettinen TA. Effect of inhibiting cholesterol absorption and synthesis on holesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. J Lipid Res 1996; 37: 1776-85.

28. Viorio AF, Gylling H, Turtola H, et al. Stanol ester margarine alone and with simvastatin lowers serum cholesterol in families with familial hypercholesterilaemia caused by the FH – North Karelia mutation. Arterioscler Thromb Vasc Biol 2000; 86: 46- 52.

29. Blair SN, Capucci DM, Gottlieb SO, et al. Incremental reduction of serum tital cholesterol and LDL-cholesterol with the addition of plant stanol ester-containing spresd to statin therspy. Am J Cardiol 2000; 86: 46-52.

30. O Neil FH, Brynes A, Mandeno R, et al. Comparison of the effects of dietary plant sterol and stanol esters on lipid metabolism. Nutr Metab Cardiowasc Dis 2004; 14: 133-42.

31. Davidson MH, Ballantyne SM, Kerzner B et al. for the Ezetimibe Study Group. Efficacy and safety of ezetimibe coadministered with statins: randomized, placebo-controlled, blinded experience in 2382 patients with primary hypercholesterolemia. Int J Clin Pract 2004; 58: 746-55.

32. Gylling H, Miettinen TA. Combination therapy with statins. Curr Opin Investig Drugs 2002; 3(9): 1318-23.

33. Gylling H, Miettinen TA. LDL cholesterol lowering by bile acid malabsorption during inhibited synthesis and absorption of cholesterol in hypercholesterolemic coronary subjects. Nutr Metab Cardiovasc Dis 2002; 12(1): 19-23.

34. Miettinen TA, Gylling H.Plant stanol and sterol esters in prevention of cardiovascular diseases: a review. Int J Clin Pharmacol Ther 2006; 44(6): 247-50.