Dtsch Med Wochenschr 2014; 139(27): 1423-1426
DOI: 10.1055/s-0034-1370134
Übersicht | Review article
Ernährungsmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Nahrungsmittelergänzung in der Prävention kardiovaskulärer Erkrankungen: Keine Empfehlung ohne Wirksamkeitsbeleg

Dietary supplements and cardiovascular diseases
N. Weingärtner
1   Abteilung für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität, Oldenburg
,
A. Elsässer
1   Abteilung für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität, Oldenburg
,
O. Weingärtner
1   Abteilung für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität, Oldenburg
› Author Affiliations
Further Information

Publication History

02 January 2014

27 April 2014

Publication Date:
17 June 2014 (online)

Zusammenfassung

Menschen mit Herzkreislauferkrankungen werden häufig Nahrungsergänzungsmittel oder sogenannte „funktionelle Lebensmittel“, d. h. Nahrungsmittel mit einem vermeintlichen Zusatznutzen, empfohlen. Ein wissenschaftlicher Wirksamkeitsbeleg im Hinblick auf „Patienten-relevante Ereignisse“, wie Herzinfarkt-und Schlaganfallrisiko liegt für diese Produkte jedoch nicht vor. Einzelne Studien zeigen, dass Nahrungsmittelergänzung unter Umständen mehr schadet als nützt. Ohne weitere Daten zur Wirksamkeit und Sicherheit sollte man mit einer allgemeinen Empfehlung zurückhaltend sein.

Abstract

Dietary supplements and so-called “functional foods” are advertised for primary and secondary prevention of cardiovascular diseases. However, there are no studies available that show that these products reduce “hard cardiovascular outcomes” such as myocardial infarction or stroke. Moreover, some studies have shown that dietary supplementation might do more harm than good. Therefore, prior to a general recommendation more data on safety and effectiveness are necessary.

 
  • Literatur

  • 1 Arzneimittelkommission der deutschen Ärzteschaft (Drug Commission of the 1. German Medical Profession). Newsletter 2004–2045 of 15.01.2004.
  • 2 Berge KE, Tian H, Graf GA et al. Accumulation of dietary cholesterol in sitosterolemia caused by mutations in adjacent ABC transporters. Science 2000; 290: 1771-1775
  • 3 Berry JD, Dyer A, Cai X et al. Lifetime risks of cardiovascular disease. N Engl J Med 2012; 366: 321-9
  • 4 Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007; 297: 842-57
  • 5 Bjelakovic G, Nikolova D, Gluud LL, Nikolova D, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev 2012; DOI: 10.1002/14651858.CD007176.pub2..
  • 6 Bolland MJ, Grey A, Gamble GD, Reid IR. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol 2014; 4: 307-320
  • 7 Burr ML, Ashfield-Watt PA, Dunstan FD et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr 2003; 57: 193-200
  • 8 Cortés-Jofré M, Rueda JR, Corsini-Munos G, Fonseca-Cortés C, Caraballoso M, Bonfill Cosp X. Drugs for preventing lung cancer in healthy people. Cochrane Database Syst Rev 2012; DOI: 10.1002/14651858.CD002141.pub2. .
  • 9 Catapano AL, Chapman J, Wiklund O, Taskinen MR. The new joint EAS/ESC guidelines for the management of dyslipidaemias. Atherosclerosis 2011; 32: 1769-1818
  • 10 Chowdhury R, Kunutsor S, Vitezova A et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 2014; 348: g1903 DOI: 10.1136/bmj.g1903..
  • 11 Clarke JT, Cullen-Dean G, Regelink E, Chan L, Rose V. Increased incidence of epistaxis in adolescents with familial hypercholesterolemia treated with fish oil. J Pediatr 1990; 116: 139-141
  • 12 Domke A et al. Verwendung von Vitaminen in Lebensmitteln. Bundesinstitut für Risikobewertung. http://www.bfr.bund.de/cm/350/ verwendung_von_vitaminen_in_lebensmitteln.pdf
  • 13 Estruch R, Ros E, Salas-Salvado J et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279-1290
  • 14 Farmer JA. Omega-3 Fatty acids and cardiovascular events after myocardial infarction: the alpha omega trial. Curr Atheroscler Rep 2011; 13: 101-103
  • 15 Genser B, Silbernagel G, De BG et al. Plant sterols and cardiovascular disease: a systematic review and meta-analysis. Eur Heart J 2012; 33: 444-451
  • 16 The GISSI Preventione Study Group. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. Lancet 1999; 354: 447-455
  • 17 Goodman GE, Thornquist MD, Balmes J et al. The Beta-Carotene and Retinol Efficacy Trial: incidence of lung cancer and cardiovascular disease mortality during 6-year follow-up after stopping beta-carotene and retinol supplements. J Natl Cancer Inst 2004; 96: 1743-1750
  • 18 Gylling H, Plat J, Turley S and the EAS Consensus Panel. et al. Plant sterols and plant stanols in the management of dyslipidemia and prevention of cardiovascular disease. Atherosclerosis 2014; 232: 346-360
  • 19 Plat J, Mackay D, Baumgartner S et al. Progress and prospective of plant sterol and plant stanol research; report of the Maastricht meating. Atherosclerosis 2012; 225: 521-533
  • 20 Kelly ER, Plat J, Mensink RP et al. Effects of long term plant sterol and -stanol consumption on the retinal vasculature: a randomized controlled trial in statin users. Atherosclerosis 2011; 214: 225-230
  • 21 Kidambi S, Patel SB. Sitosterolaemia: pathophysiology, clinical presentation and laboratory diagnosis. J Clin Pathol 2008; 61: 588-94
  • 22 King DE, Mainous III AG, Matheson EM, Everett CJ. Impact of healthy lifestyle on mortality in people with normal blood pressure, LDL cholesterol, and C-reactive protein. Eur J Cardiovasc Prev Rehabil 2011; 20: 73-79
  • 23 Klein EA, Thompson Jr IM, Tangen CM et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011; 306: 1549-1556
  • 24 Kmietowicz Z. Vitamin D shows no clear evidence of benefits despite hundreds of studies. BMJ 2014; 348: g2489
  • 25 Kromhout D, Giltay EJ, Geleijnse JM. n-3 fatty acids and cardiovascular events after myocardial infarction. N Engl J Med 2010; 363: 2015-26
  • 26 Laufs U, Schirmer S. Margarines supplemented with low dose n-3 fatty acids are not effective in secondary prevention. Eur Heart J 2012; 33: 1555-7
  • 27 Bundesinstitut für Risikobewertung. Lebensmittel mit Pflanzensterol- und Pflanzenstanol-Zusatz: Bewertung einer neuen Studie aus den Niederlanden. http://www.bfr.bund.de/cm/343/lebensmittel-mit-pflanzensterol-und-pflanzenstanol-zusatz-bewertung-einer-neuen-studie-aus-den-niederlanden.pdf (letzter Zugriff 2.6.2014)
  • 28 Lee MH, Lu K, Hazard S et al. Identification of a gene, ABCG5, important in the regulation of dietary cholesterol absorption. Nat Genet 2001; 27: 79-83
  • 29 Lichtenstein AH, Appel LJ, Brands M et al. Summary of American Heart Association Diet and Lifestyle Recommendations revision 2006. Arterioscler Thromb Vasc Biol 2006; 26: 2186-2191
  • 30 Bundesinstitut für Risikobewertung. Menschen mit normalen Cholesterinwerten sollten auf den Verzehr von Lebensmitteln mit zugesetzten Pflanzensterinen verzichten. http://bfr.bund.de/ cm/343/menschen_mit_normalen_cholesterinwerten.pdf (letzter Zugriff 2.6.2014)
  • 31 Meydani SN, Lichtenstein AH, Cornwall S et al. Immunologic effects of national cholesterol education panel step-2 diets with and without fish-derived N-3 fatty acid enrichment. J Clin Invest 1993; 92: 105-113
  • 32 Muldoon MF, Manuck SB, Mendelsohn AB, Kaplan JR, Belle SH. Cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials. BMJ 2001; 322: 11-15
  • 33 Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR Jr. Dietary supplements and mortality rate in older women: the Iowa Women's Health Study. Arch Intern Med 2011; 171: 1625-1633
  • 34 National Institute for Health and Clinical Excellence. LIPID MODIFICATION. Cardiovascular risk assessment and the modification of blood lipids for theprimary and secondary prevention of cardiovascular disease. www.guidance.nice.org.uk/CG67 (letzter Zugriff 11. Juni 2014)
  • 35 Omenn GS, Goodman GE, Thornquist MD et al. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 1996; 334: 1150-1155
  • 36 Patel MD, Thompson PD. Phytosterols and vascular disease. Atherosclerosis 2006; 186: 12-19
  • 37 Rideout TC, Harding SV, Mackay D, Abumweiss SS, Jones PJ. High basal fractional cholesterol synthesis is associated with nonresponse of plasma LDL cholesterol to plant sterol therapy. Am J Clin Nutr 2010; 92: 41-46
  • 38 Rubis B, Paszel A, Kaczmarek M et al. Beneficial or harmful influence of phytosterols on human cells?. Br J Nutr 2008; 100: 1183-91
  • 39 Silbernagel G, Fauler G, Hoffmann MM et al. The associations of cholesterol metabolism and plasma plant sterols with all-cause- and cardiovascular mortality. J Lipid Res 2010; 51: 2384-93
  • 40 Stone NJ, Robinson J, Lichtenstein AH et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2013; doi:10.1016/j.jacc.2013.11.002.
  • 41 Sudhop T, von Bergmann K. Sitosterolemia – a rare disease. Are elevated plant sterols an additional risk factor?. Z Kardiol 2004; 93: 921-928
  • 42 Teupser D, Baber R, Ceglarek U et al. Genetic regulation of serum phytosterol levels and risk of coronary artery disease. Circ Cardiovasc Genet 2010; 3: 331-339
  • 43 Theobald HE, Chowienczyk PJ, Whittall R, Humphries SE, Sanders TA. LDL cholesterol-raising effect of low-dose docosahexaenoic acid in middle-aged men and women. Am J Clin Nutr 2004; 79: 558-63
  • 44 Vanhanen HT, Blomqvist S, Ehnholm C et al. Serum cholesterol, cholesterol precursors, and plant sterols in hypercholesterolemic subjects with different apoE phenotypes during dietary sitostanol ester treatment. J Lipid Res 1993; 34: 1535-1544
  • 45 Weingärtner O, Laufs U. Primär und Sekundärprävention des akuten Koronarsyndroms. Hamostaseologie 2006; 26: 158-166
  • 46 Weingärtner O, Böhm M, Laufs U. Controversial role of plant sterol esters in the management of hypercholesterolaemia. Eur Heart J 2009; 30: 404-9
  • 47 Weingärtner O, Böhm M, Laufs U. Nahrungsmitteladditiva in der Prävention kardiovaskulärer Erkrankungen. Dtsch Med Wochenschr 2008; 133: 1201-1204
  • 48 Weingärtner O, Lütjohann D, Böhm M, Laufs U. Relationship between cholesterol synthesis and intestinal absorption is associated with cardiovascular risk. Atherosclerosis 2010; 210: 362-365
  • 49 Weingärtner O, Lütjohann D, Ji S et al. Vascular effects of diet supplementation with plant sterols. J Am Coll Cardiol 2008; 51: 1553-1561
  • 50 Weingärtner O, Ulrich C, Lütjohann D et al. Differential effects on inhibition of cholesterol absorption by plant stanol and plant sterol esters in apoE-/- mice. Cardiovasc Res 2011; 90: 484-492
  • 51 Weingärtner O, Weingärtner N, Scheller B et al. Alterations in cholesterol homeostasis are associated with coronary heart disease in patients with aortic stenosis. Coron Artery Dis 2009; 20: 376-382
  • 52 Malhorta A, Shafiq N, Arora A et al. Dietary interventions (plant sterols, stanols, omega-3 fatty acids, soy protein and dietary fibers) for familial hypercholesterolemia. Cochrane Database Syst Rev. 2014; Jun 10;6: CD001918 (epub ahead of print)