The effect of phytosterol supplementation on endothelial function in adults: a systematic review and dose-response meta-analysis of randomized controlled trials
- 1Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- 2Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- 3Health and Environment Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
Abstract
Background and aims: While the cholesterol-lowering properties of phytosterols are well established, their effects on cardiovascular health, particularly endothelial dysfunction and low-grade inflammation, remain insufficiently explored. This meta-analysis aimed to evaluate the impact of phytosterol supplementation on endothelial function in adults using key vascular biomarkers.
Methods and results: A systematic search of major databases up to March 2026 identified randomized controlled trials comparing phytosterol supplementation with placebo or control. Eligible studies assessed endothelial function using flow-mediated dilation (FMD) or markers of endothelial activation, such as vascular cell adhesion molecule-1 (VCAM-1). Random-effects models were applied to pool effect sizes, and subgroup and dose-response analyses were performed. Ten randomized controlled studies (14 effect sizes; 1,278 participants) were included, comprising six studies contributing eight effect sizes for FMD (n = 802) and four studies contributing six effect sizes for VCAM-1 (n = 476). Phytosterol supplementation showed no significant effect on FMD (mean difference: -0.05%, 95% CI: -0.61 to 0.51; P = 0.857) or VCAM-1 (standardized mean difference: -0.16, 95% CI: − 0.34 to 0.03; P = 0.098). Dose-response and meta-regression analyses indicated no significant association of either dose or treatment duration with endothelial outcomes (all P > 0.3).
Conclusion: Based on current evidence, no statistically significant effect of phytosterol supplementation on endothelial function was observed. Further long-term, well-designed randomized trials, particularly in high-risk populations, are required to better elucidate potential vascular effects.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40795-026-01443-9.
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BibTeX
@article{zamanian2026effect,
title = {{The effect of phytosterol supplementation on endothelial function in adults: a systematic review and dose-response meta-analysis of randomized controlled trials}},
author = {Nazanin Zamanian and Sepide Talebi and Mehran Rahimlou and Hamed Mohammadi},
journal = {BMC Nutrition},
year = {2026},
month = jul,
doi = {10.1186/s40795-026-01443-9},
url = {https://doi.org/10.1186/s40795-026-01443-9},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - The effect of phytosterol supplementation on endothelial function in adults: a systematic review and dose-response meta-analysis of randomized controlled trials
AU - Nazanin Zamanian
AU - Sepide Talebi
AU - Mehran Rahimlou
AU - Hamed Mohammadi
PY - 2026
DA - 2026/07/01
JO - BMC Nutrition
DO - 10.1186/s40795-026-01443-9
UR - https://doi.org/10.1186/s40795-026-01443-9
AB - Background and aims: While the cholesterol-lowering properties of phytosterols are well established, their effects on cardiovascular health, particularly endothelial dysfunction and low-grade inflammation, remain insufficiently explored. This meta-analysis aimed to evaluate the impact of phytosterol supplementation on endothelial function in adults using key vascular biomarkers. Methods and results: A systematic search of major databases up to March 2026 identified randomized controlled trials comparing phytosterol supplementation with placebo or control. Eligible studies assessed endothelial function using flow-mediated dilation (FMD) or markers of endothelial activation, such as vascular cell adhesion molecule-1 (VCAM-1). Random-effects models were applied to pool effect sizes, and subgroup and dose-response analyses were performed. Ten randomized controlled studies (14 effect sizes; 1,278 participants) were included, comprising six studies contributing eight effect sizes for FMD (n = 802) and four studies contributing six effect sizes for VCAM-1 (n = 476). Phytosterol supplementation showed no significant effect on FMD (mean difference: -0.05%, 95% CI: -0.61 to 0.51; P = 0.857) or VCAM-1 (standardized mean difference: -0.16, 95% CI: − 0.34 to 0.03; P = 0.098). Dose-response and meta-regression analyses indicated no significant association of either dose or treatment duration with endothelial outcomes (all P > 0.3). Conclusion: Based on current evidence, no statistically significant effect of phytosterol supplementation on endothelial function was observed. Further long-term, well-designed randomized trials, particularly in high-risk populations, are required to better elucidate potential vascular effects. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40795-026-01443-9.
SN - 2055-0928
ER -