“Add-on” effect of phytosterols-enriched fermented milk on lipids and markers of cholesterol metabolism in statin-treated elderly patients

The effect of plant sterol (PS) enriched matrices on lipid profile has been evaluated in statin-treated individuals, with LDL-C concentrations between 3.35 mmol/L and 4.90 mmol/L, but studies in the elderly are scarce. In this study the additional effect of a low-fat PS-enriched fermented milk (PS-FM) on cholesterol metabolism markers and serum lipids was evaluated in the elderly on stable statin therapy with baseline LDL-C < 3.35 mmol/L. Thirty-five individuals (88.6% women; 81 ± 8 years old; BMI 29.9 ± 6.0 kg/m2), living in elderly nursing care facilities were placed on a daily intake of 2 g PS-FM for 6 weeks, in addition to their statin monotherapy. A fasting blood sample was collected at baseline (t0), after 2 consecutive periods of 3 weeks intake (t1 and t2), and after 6 weeks of washout (t3), for the analysis of serum lipid profile and cholesterol synthesis (lathosterol, desmosterol) and absorption (sitosterol, campesterol and cholestanol) markers. PS-FM consumption led to a LDL-C reduction of 0.15 mmol/L (t1) and 0.27 mmol/L (t2) from baseline (P < 0.05). Serum campesterol and sitosterol (P < 0.001) increased (t0-t1; t0-t2), reflecting PS intake and contributing to the inhibition of cholesterol intestinal absorption, leading to a decrease in cholestanol-to-cholesterol ratio. There was a reciprocal homeostatic rise of serum cholesterol precursors, desmosterol and lathosterol (P < 0.001) from baseline, based on the up-regulation of the opposing pathway. Statin-treated elderly individuals, with baseline LDL-C < 3.35 mmol/L, may still have therapeutic benefit from strategies that reduce cholesterol absorption, such as 2 g/day PS-FM.