Phytosterols and Sterol Esters in Cardiovascular Health: Mechanisms, Benefits, and Clinical Perspectives

Cardiovascular disease (CVD) is one of the leading causes of death worldwide, with high level of low-density lipoprotein cholesterol (LDL-C) being a key risk factor. There is increasing interest in dietary strategies and functional foods as complementary strategies for lowering cholesterol, with a daily intake of 2-3 g phytosterols reducing LDL-C by 8-10% through inhibited intestinal absorption. Although increasing research report that the anti-inflammatory and antioxidative properties of phytosterols could also benefit CVD prevention, how exactly these bioactivities could contribute to CVD intervention requires in-depth exploration. This review explores the role of phytosterols in CVD prevention, focusing on their effects on cholesterol metabolism, inflammation, and oxidative stress. Therefore, this review aims to elucidate the link between phytosterols’ bioactivity and CVD prevention by comprehensively examining their effects on cholesterol metabolism, inflammation, and oxidative stress. Furthermore, it highlights key research gaps and future directions, including personalized nutrition strategies to improve absorption and efficacy. Addressing these challenges will help optimize the role of phytosterols in cardiovascular health management.