Advertisement

Responsiveness of Plasma Lipids and Lipoproteins to Plant Stanol Esters

  • Nilo B. Cater
    Affiliations
    Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas, Texas, USA

    Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas, Texas, USA
    Search for articles by this author
  • Ana-Barbara Garcia-Garcia
    Affiliations
    Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas, Texas, USA
    Search for articles by this author
  • Gloria Lena Vega
    Affiliations
    Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas, Texas, USA

    Department of Clinical Nutrition, University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas, Texas, USA
    Search for articles by this author
  • Scott M. Grundy
    Correspondence
    Address for reprints: Scott M. Grundy, MD, PhD, Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Y3.202, Dallas, Texas 75390-9052.
    Affiliations
    Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas, Texas, USA

    Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas, Texas, USA

    Department of Clinical Nutrition, University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas, Texas, USA
    Search for articles by this author
      Plant stanols have been shown to reduce serum levels of low-density lipoprotein (LDL) cholesterol, and they are an attractive adjunct in dietary therapy for elevated LDL cholesterol. This investigation addressed 3 questions through metabolic studies in human subjects: (1) whether plant stanol esters given at higher doses than the 2-g/day dose recommended by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) will provide additional LDL-lowering efficacy (study 1); (2) whether substantial reduction in LDL cholesterol can be obtained in postmenopausal women with hypercholesterolemia by addition of plant stanol esters to the diet (study 2); and (3) whether ATP III goals can be obtained by adding plant stanol esters to an LDL-lowering regimen in high-risk patients who retain LDL cholesterol levels in the above-optimal range (ie, 2.6 to 3.3 mmol/L [100 to 129 mg/dL]), despite ongoing statin therapy (study 3). Study 1 showed that maximal LDL lowering with plant stanols in the form of esters can be achieved at a dose of 2 g/day. Higher doses do not provide additional efficacy. Study 2 demonstrated that stanol esters can reduce LDL cholesterol levels in postmenopausal women by about 13%, which makes use of stanol esters attractive as a component of nondrug therapy in these women who generally are at relatively low risk for coronary heart disease. Finally, study 3 found that plant stanols provide additional lowering of LDL cholesterol when added to ongoing statin therapy. This makes plant stanols an attractive dietary component to help to achieve the goals of LDL-lowering therapy in patients requiring an LDL-lowering drug.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cater N.B.
        Historical and scientific basis for the development of plant stanol ester foods as cholesterol-lowering agents.
        Eur Heart J. 1999; 1: S36-S44
        • Katan M.B.
        • Grundy S.M.
        • Jones P.
        • Law M.
        • Miettinen T.
        • Paoletti R.
        • Stresa Workshop Participants
        Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels.
        Mayo Clin Proc. 2003; 78: 965-978
        • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
        Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.
        Circulation. 2002; 106: 3143-3421
        • Vega G.L.
        • Ma P.T.
        • Cater N.B.
        • Filipchuk N.
        • Meguro S.
        • Garcia-Garcia A.B.
        • Grundy S.M.
        Effects of adding fenofibrate (200 mg/day) to simvastatin (10 mg/day) in patients with combined hyperlipidemia and metabolic syndrome.
        Am J Cardiol. 2003; 91: 956-960
        • Vega G.L.
        • Grundy S.M.
        Quantitation of apolipoprotein B by chemical methods.
        Methods Enzymol. 1996; 263: 63-82
        • Luhr T.A.
        Use of a high-sensitivity C-reactive protein assay in evaluating cardiovascular disease risk.
        Am Clin Lab. 2000; 19: 20-21
        • Miettinen T.A.
        • Tilvis R.S.
        • Kesaniemi Y.A.
        Serum plant sterols and cholesterol precursors reflect cholesterol absorption and synthesis in volunteers of a randomly selected male population.
        Am J Epidemiol. 1990; 131: 20-31
        • Lees A.M.
        • Mok H.Y.
        • Lees R.S.
        • McCluskey M.A.
        • Grundy S.M.
        Plant sterols as cholesterol-lowering agents.
        Atherosclerosis. 1977; 28: 325-338
        • Denke M.A.
        Lack of efficacy of low-dose sitostanol therapy as an adjunct to a cholesterol-lowering diet in men with moderate hypercholesterolemia.
        Am J Clin Nutr. 1995; 61: 392-396
        • Wilson P.W.
        • D’Agostino R.B.
        • Levy D.
        • Belanger A.M.
        • Silbershatz H.
        • Kannel W.B.
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97: 1837-1847
        • Jenkins D.J.
        • Kendall C.W.
        • Marchie A.
        • Faulkner D.A.
        • Wong J.M.
        • de Souza R.
        • Emam A.
        • Parker T.L.
        • Vidgen E.
        • Lapsley K.G.
        • et al.
        Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein.
        JAMA. 2003; 290: 502-510
        • Kendall C.W.
        • Jenkins D.J.
        A dietary portfolio.
        Curr Atheroscler Rep. 2004; 6: 492-498
        • Blair S.N.
        • Capuzzi D.M.
        • Gottlieb S.O.
        • Nguyen T.
        • Morgan J.M.
        • Cater N.B.
        Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy.
        Am J Cardiol. 2000; 86: 46-52
        • Stein E.
        • Stender S.
        • Mata P.
        • Sager P.
        • Ponsonnet D.
        • Melani L.
        • Lipka L.
        • Suresh R.
        • Maccubbin D.
        • Veltri E.
        • Ezetimibe Study Group
        Achieving lipoprotein goals in patients at high risk with severe hypercholesterolemia.
        Am Heart J. 2004; 148: 447-455
        • Ray K.K.
        • Cannon C.P.
        Intensive statin therapy in acute coronary syndromes.
        Curr Opin Lipidol. 2004; 15: 637-643
        • Grundy S.M.
        • Vega G.L.
        • McGovern M.E.
        • Tulloch B.R.
        • Kendall D.M.
        • Fitz-Patrick D.
        • Ganda O.P.
        • Rosenson R.S.
        • Buse J.B.
        • Robertson D.D.
        • Sheehan J.P.
        • Diabetes Multicenter Research Group
        Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes.
        Arch Intern Med. 2002; 162: 1568-1576
        • Coban E.
        • Sari R.
        The effect of fenofibrate on the levels of high sensitivity C-reactive protein in dyslipidemic obese patients.
        Endocr Res. 2004; 30: 343-349
        • Bays H.E.
        • Ose L.
        • Fraser N.
        • Tribble D.L.
        • Quinto K.
        • Reyes R.
        • Johnson-Levonas A.O.
        • Sapre A.
        • Donahue S.R.
        • Ezetimibe Study Group
        A multicenter, randomized, double-blind, placebo-controlled, factorial design study to evaluate the lipid-altering efficacy and safety profile of the ezetimibe/simvastatin tablet compared with ezetimibe and simvastatin monotherapy in patients with primary hypercholesterolemia.
        Clin Ther. 2004; 26: 1758-1773