Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease

Objective: This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy
lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk.
Methods and results: Plant sterols/stanols (when taken at 2 g/day) cause significant inhibition of
cholesterol absorption and lower LDL-C levels by between 8 and 10%. The relative proportions of
cholesterol versus sterol/stanol levels are similar in both plasma and tissue, with levels of sterols/stanols
being 500-/10,000-fold lower than those of cholesterol, suggesting they are handled similarly to
cholesterol in most cells. Despite possible atherogenicity of marked elevations in circulating levels of
plant sterols/stanols, protective effects have been observed in some animal models of atherosclerosis.
Higher plasma levels of plant sterols/stanols associated with intakes of 2 g/day in man have not been
linked to adverse effects on health in long-term human studies. Importantly, at this dose, plant sterol/
stanol-mediated LDL-C lowering is additive to that of statins in dyslipidaemic subjects, equivalent to
doubling the dose of statin. The reported 6e9% lowering of plasma triglyceride by 2 g/day in hypertriglyceridaemic patients warrants further evaluation.
Conclusion: Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel
concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high
cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve
LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial
hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are
no randomised, controlled clinical trial data with hard end-points to establish clinical benefit from the
use of plant sterols or plant stanols.