Despite the vast literature on phytostor's lowering blood cholesterol levels,

there is to date no study investigating the ultimate proof of efficacy, the lowering of the incidence of coronary heart disease.

This is probably the strongest argument against them.

There are no studies with hard endpoints to confirm that the drop in LDL cholesterol

from plant sterols translates to a drop in heart attacks.

The reason is that even if people start out with a 10-year cardiovascular disease risk of 10%,

you'd have to randomize about 30,000 people

to phytosterols for a decade to detect such an effect.

And at a more reasonable 10-year risk of 5%, you might have to enroll more than 300,000.

Now, one could argue that the cholesterol lowering is all we need to know, since basically lowering LDL cholesterol by any means appears to lower cardiovascular risk, whether by statins,

other kinds of drugs, diet, or surgery.

However, there was a big trial of extended release niacin in a group of patients with LDLs starting down in the low 60s,

and researchers saw a further 10-point drop after a few years that should have dropped

their risk by at least 5 or 6 percent, but failed to offer a statistically significant benefit

in the end, so there's at least one example of that line of argument failing. There is that azetamide that does have a similar mechanism of action as

phytosterols, that is, blocking cholesterol absorption.

It partially blocks the cholesterol absorption receptor,

so cholesterol absorption is reduced by about 50 percent.

When it was put to the test, it did indeed significantly

improved cardiovascular outcomes, and the 13-point drop in L-DLDL achieved by blocking cholesterol

absorption with the drug is almost the exact same drop in LDL we'd expect from blocking

cholesterol absorption with phytosterols based on more than 100 randomized controlled trials. Does blocking cholesterol absorption with phytosterols based on more than 100 randomized controlled

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