I had wondered if using phytosterols and ezetimibe together would have any effect on lipid lowering. I am glad to see that the combination was studied recently and reported. (1)
My take home on this article is that the combination of ezetimibe and phytosterols lowered LDL and non-HDL cholesterol more than ezetimibe alone. The reported benefit was a drop from LDL of 129 mg/dL to 108 mg/dL with ezetimibe and to 101 mg/dL when combined with with phytosterols. It does sound more impressive when you say ezetimibe drops the LDL by 16% and ezetimibe and phytosterols drops it by 22% relative to placebo. Non-HDL cholesterol dropped about the same amount when reported with 158 mg/dL to 135 mg/dL to 128 mg/dL which is probably the same absolute drop, but percentages of course are different being 14% and 18%. Also of interest was that triglycerides dropped with each treatment, but more with the ezetimibe and phytosterols than other treatments. It was noted in the article that ezetimibe did raise the HDL statistically compared with placebo or ezetimibe and phytosterols, however the numbers were 38 mg/dL vs 40 mg/dL vs 39 mg/dL, which does not seem all that biologically important.
What foods are high in phytosterols (2) . In mg/100mg Oils have the highest concentration: Rice Bran 1055, Corn 952, Wheat germ 553, Flax seed 338, Cottonseed 327, Soybean 221, Peanut 206, Olive 176, Coconut 91 and Palm 49. Most fruits and Vegetables are not great sources of plant sterols, but Nuts and Legumes do have more than most. (160 to 120).
This suggests that a diet rich in plant sterols (phytosterols) will enhance the effect of ezetimibe. I am not advocating additives, but I again suggest a diet rich in whole grains, nuts, fruits and vegetables. This study shows one of the ways that diet may be helpful.
1. Combined Effects of Ezetimibe and Phytosterols on Cholesterol metabolism: A Randomized, Controlled Feeding Study in Humans doi:10.1161/CIRCULATIONAHA.110.006692 http://circ.ahajournals.org/content/124/5/596
2. http://www.dietaryfiberfood.com/cholesterol-low.php
Bryan E Fuhs MD reviewed 8/29/2011