Plant Stanol/Sterol Ester‐Containing Foods and Cardiovascular Disease Risk

Cardiovascular disease (CVD) is the leading cause of death and disability in the United States, and an elevated low‐density‐lipoprotein (LDL) cholesterol level is one risk factor. The primary nonpharmacological approach to reducing LDL‐cholesterol levels is to restrict dietary saturated fat and cholesterol. Adjunct strategies are frequently superimposed as well. One newer approach is to substitute foods containing plant sterol/stanol esters for conventional foods such as margarines and salad dressings. Daily consumption of 2–3 g of plant sterol/stanol esters has been reported to reduce LDL‐cholesterol levels by 9% to 20%, with considerable individual variability. This cholesterol lowering appears additive to that achieved with saturated fat and cholesterol restriction or use of hydroxymethylgluteryl‐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. However, declines in plasma carotenoids and tocopherol levels have been reported. The clinical significance of this observation is unknown but needs further evaluation. Plant sterol/stanol ester‐containing foods can be used to augment a low‐saturated‐fat and low‐cholesterol diet; however, patients should be cautioned that use beyond the manufacturer‐recommended levels will not result in greater LDL‐cholesterol lowering. If a patient decides to use plant sterol/stanol ester‐containing foods, they should be substituted, not added, to the diet to avoid increasing caloric intake. Additionally, there is no evidence that use of sterol/stanol ester‐containing foods in normocholesterolemic individuals will prevent the onset of elevated cholesterol levels.