STANOL/STEROL ESTER-CONTAINING FOODS AND CARDIOVASCULAR DISEASE RISK

Authors: LICHTENSTEIN, ALICE - HNRCA

Submitted to: Nutrition in Clinical Care
Publication Type: Review Article
Publication Acceptance Date: 7/1/2000
Publication Date: 9/1/2000
Citation: LICHTENSTEIN, A.H. STANOL/STEROL ESTER-CONTAINING FOODS AND CARDIOVASCULAR DISEASE RISK. NUTRITION IN CLINICAL CARE. 2000;3:274-278.

Interpretive Summary:

Technical Abstract: Cardiovascular disease (CVD) is the leading cause of death and disability in the United States. One risk factor for the development of CVD is elevated low density lipoprotein (LDL) cholesterol levels. The primary nonpharmacological approach to reducing LDL cholesterol levels is to restrict the saturated fat and cholesterol content of the diet. Additional strategies are frequently superimposed along with this basic guidance. One newer approach is to substitute foods containing plant sterol/stanol esters for conventional foods such as margarines and salad dressings. Intake of 2-3 grams of plant sterol/stanol esters has been reported to reduce LDL cholesterol levels by 9% to 20%. Individual results varied. This cholesterol lowering appears to be additive to that achieved with saturated fat and cholesterol restriction or the use of hydroxymethylglut- eryl CoA reductase inhibitors. The hypocholesterolemic effect of plant sterol/stanol esters is thought to be mediated primarily by decreasing intestinal cholesterol absorption. Few adverse effects have been reported for short and long term use of sterol/stanol ester containing foods. Declines in plasma carotenoids and tocopherol levels have been reported. The use of plant sterol/stanol esters containing foods can augment a low saturated fat and cholesterol diet. Patients must be cautioned that excess use, beyond that recommended by the manufacturer, will not result in increased LDL cholesterol lowering. If a patient uses plant sterol/stanol ester containing foods, they should be substituted, not added, to the diet to avoid increasing caloric intake. There is no evidence that prophylactic use of sterol/stanol esters in normocholesterolemic individuals is effective in preventing the onset of elevated cholesterol levels.