The health and welfare benefits of phytosterol supplementation

There is mounting evidence that billions of Euros of healthcare costs associated with cardiovascular disease (CVD) could be avoided through more widespread food supplementation among target populations across the EU

A new study, commissioned by Food Supplements Europe (FSE), has found that savings of €5.3 billion a year could be generated through the daily consumption of 1.7g of phytosterols by the millions of adults aged 55 and older in the EU with severe hypercholesterolemia.

Hypercholesterolemia is the presence of high levels of LDL cholesterol in the blood, which is strongly associated with a higher risk of CVD. Across the European Union (EU), 31.1 million 55-plus individuals are living with severe hypercholesterolemia. They have an estimated 24.3% risk of experiencing a CVD-attributed hospital event as a result.

It is the second study in the space of a year to highlight the huge potential that exists for generating healthcare cost savings in relation to CVD through more widespread food supplementation among target populations in the EU. In 2016, Frost & Sullivan’s researchers reported that €13 billion a year in healthcare cost savings could be generated through the daily consumption of 1000mg of omega-3 EPA+DHA food supplements.

Food Supplements Europe Chair, Ingrid Atteryd, said: “A very clear picture is emerging of the significant economic and well-being benefits that could be achieved by encouraging more widespread food supplementation among those sections of the EU population at greatest risk of experiencing a CVD-attributed hospital event. Having already demonstrated the cost savings possible through greater supplementation with fish oil, we are now able to see the potential for substantial economies through more widespread consumption of phytosterols. It’s a clear indication that food supplementation can make a highly positive contribution in the EU both financially and in terms of quality of life.”

The newly published phytosterols report is the third in a series by Frost & Sullivan (F&S). The first addressed omega-3 and CVD, whereas the second — published in February 2017 — explored the cost saving benefits of calcium + vitamin D supplementation in the context of avoiding bone fractures among the 27.8 million people in the EU aged 55 and older and living with osteoporosis. It was found that savings of €3.96 billion a year were achievable.

Improved health and cost savings

To find out more, NBR’s Dr Kevin Robinson caught up with Patrick Coppens, FSE’s Director, Regulatory and Scientific Affairs, at this year’s Vitafoods Europe.

“This is the third in a series of reports in which we've investigated the effect of dietary supplementation with selected food compounds. As you know, we first looked at omega-3 fatty acids, the second study focused on calcium and vitamin D, and this new research has put the spotlight on phytosterols, which are natural components of food; but, of course, if you only obtain them from food, you only get about 300mg, which is not sufficient to have an effect on LDL cholesterol levels,” he said.

Patrick continued: “I think phytosterols are probably one of the most well researched ingredients in food science; there have been about 85 trials looking into their cholesterol lowering effect … and these trials consistently show that if you take approximately 2g/day, they can reduce your LDL cholesterol levels by 8–10%. This is actually quite significant, given the prevalence of hypercholesterolemia — also called dyslipidaemia — in Europe, which has a proven link to cardiovascular disease (CVD).”

“If you take that equation, which is also supported by an EFSA health claim, and you look at the huge burden of CVD in Europe, you get a figure of about 7.7 million cardiovascular events that could be avoided if overall cholesterol levels were much lower.”

“Of course, hypercholesterolemia is not just a food issue; genetics play a role, as do lifestyle factors such as smoking and lack of physical activity. But if you single out the effect of phytosterols, you can achieve a risk reduction factor of 2.3%, which translates to 170,000 events that could be prevented (if the total at-risk population increased their phytosterol intake levels).”

“We looked at the high-risk group, those who are older than 55 and those with severely high cholesterol levels. The effect would probably be a lot higher if we also included people with moderately high cholesterol levels. All these avoided events would not only provide a benefit for the people involved, it would also significantly improve the financial situation of the relevant healthcare systems. The cost of managing and treating CVDs is astronomical, about €34,000 per case on average!”

Independent researchers from Frost & Sullivan calculated the economic burden of addressing cases of CVD linked to hypercholesterolemia among this population and discovered it is set to cost EU healthcare systems and providers €1.328 trillion between 2016 and 2020, €266 billion a year, which is equivalent to €34,637 per event.

Phytosterols are proven to reduce levels of LDL cholesterol. Following an analysis of the available science, Frost & Sullivan’s research team concluded that the supplemental consumption of just 1.7g of phytosterols a day by EU adults aged 55-plus with severe hypercholesterolemia would cut their risk of experiencing a CVD-attributed hospital event associated with their condition by 2.3% basis points. In turn, this would result in cost savings of €26.5 billion during a 5-year period, or €5.3 billion a year.

“This is a slightly lower figure than the omega-3 research generated, but still represents considerable savings,” adds Patrick.

Implementing change

When I asked Patrick what the driver was behind the research, he told me that, first of all, it had never been done before!

“Sometimes,” he explained, “food supplements are not considered to be particularly important by policy makers. We’re constantly finding that, contrary to received wisdom, eating a balanced diet is just not enough. We’re hoping that the report will highlight that not only do food supplements play a role in reducing the risk of disease, but that if Member State policy makers are better educated about their benefits, they’ll realise that significant healthcare cost savings can be made. It’s very much about raising awareness.”

“Armed with knowledge, it’s a much simpler path to introducing nutritional recommendations and, subsequently passing that information on to consumers who then become aware that they can reduce their risk of a cardiovascular event by taking these supplements.”

Going further the F&S study also shows very clearly that even accounting for the cost of supplementation, the savings to be made are still substantial. For phytosterols, for example, the return on investment is €4.3 for every Euro spent. A reimbursement policy for such products, when taken by people who genuinely need them, would be, we feel, very effective … but that’s a long way off at the moment.”

Whether the savings derived from the phytosterol study and the previous omega-3 research can be combined to increase the cost-effectiveness of supplementation, Patrick is unsure: “One plus one does not always equal two,” he says.

“Both can play a role, and can help to reduce risk. Both phytosterols and omega-3s can lower cholesterol levels, but whereas phytosterols are linked to hypercholesterolemia and then to cardiovascular disease, omega-3s have a direct link to CVDs. Together, they’ll have a greater effect than one or the other, but cutting out smoking, losing weight and taking more exercise will also help.”

Looking ahead

What’s next I asked? “When we started this exercise,” says Patrick, “we weren’t even sure the outcome would be positive. Now, we’re looking at other ingredients and other health conditions to ascertain whether there is evidence to support cost savings that could be implemented as a result of supplementation with specific compounds or food components.”

Ms Atteryd concluded: “This series of in-depth and rigorous healthcare cost savings reports commissioned by Food Supplements Europe highlights an important opportunity to enhance the health and well-being of millions of EU citizens, while also making significant cost savings that could ease the enormous financial pressure on healthcare systems. More than ever, it is now impossible to ignore the fact that supplementation can play an absolutely vital role in the future of how healthcare in the EU is funded, resourced and delivered.”

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