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Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials

Jovanovski E, Yashpal S, Komishon A, et al. (2018)

Am J Clin Nutr · PMID 30239559

Abstract

BACKGROUND: Studies have identified viscous dietary fiber as potentially attenuating cholesterol, including psyllium, which reduces LDL cholesterol and thus may complement cardiovascular disease (CVD) treatment. OBJECTIVES: The aims of this study were to update evidence on the effect of psyllium on LDL cholesterol and to provide an assessment of its impact on alternate markers: non-HDL cholesterol and apolipoprotein B (apoB). DESIGN: Medline, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched through 3 October 2017. Independent reviewers extracted relevant data and assessed risk of bias. We included randomized controlled trials with a duration of &#x2265;3 wk that assessed the effect of psyllium on blood lipids in individuals with or without hypercholesterolemia. Data were pooled by using the generic inverse variance method with random-effects models and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed by Cochran's Q statistic and quantified by the I2 statistic. Overall quality of the evidence was assessed by using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. RESULTS: We included 28 trials in our analysis (n&#xa0;=&#xa0;1924). Supplementation of a median dose of &#x223c;10.2 g psyllium significantly reduced LDL cholesterol (MD&#xa0;=&#xa0;-0.33 mmol/L; 95% CI: -0.38, -0.27 mmol/L; P&#xa0;<&#xa0;0.00001), non-HDL cholesterol (MD&#xa0;=&#xa0;-0.39 mmol/L; 95% CI: -0.50, -0.27 mmol/L; P&#xa0;<&#xa0;0.00001), and apoB (MD&#xa0;=&#xa0;-0.05 g/L; 95% CI: -0.08, -0.03 g/L; P&#xa0;<&#xa0;0.0001). Effect estimates for LDL cholesterol and non-HDL cholesterol were graded as moderate quality on the basis of downgrades for inconsistency and graded as high quality for apoB. CONCLUSION: Psyllium fiber effectively improves conventional and alternative lipids markers, potentially delaying the process of atherosclerosis-associated CVD risk in those with or without hypercholesterolemia. This trial is registered at www.clinicaltrials.gov as NCT03346733.