Renewal has occurred in the use of
plant sterols for the treatment of
hypercholesterolemias. A novel development was to convert
plant sterols to corresponding stanols and esterify them to fat soluble form. In contrast to the crystalline
plant sterols or stanols, plant stanol
esters can be easily consumed during normal food intake in soluble form in different fat-containing food constituents when they have a potent
cholesterol-lowering effect, shown in normo- and hypercholesterolemic men and women without or with
coronary heart disease, children and diabetes.
Cholesterol lowering is approximately 10% for total and 15% for
LDL cholesterol, with the respective values for stanol
ester margarine (2-3 g/day stanols) being 15% and 20%. Stanol
esters reduce
cholesterol absorption efficiency by up to 65%, increase
cholesterol elimination in feces as
cholesterol itself, usually not as
bile acids, and stimulate
cholesterol synthesis. Serum
beta-carotene level is lowered, but no fat malabsorption or lowering of serum fat soluble
vitamins have been observed. In contrast to
plant sterols, stanols and their
esters are minimally absorbed and they reduce serum
plant sterol concentrations, also preventing
statin-induced increase of
plant sterols. Stanol
ester margarine has been included in dietary treatment of
hypercholesterolemia followed by the addition of
drug treatment in resistant cases.