23.08.2011 Copyright® Raisio

Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine

Gylling H et al., Circulation, 1997

Gylling et al. 1997 2

Objectives

To investigate the serum cholesterol lowering effect of sitostanol ester margarine alone and in combination with statins in postmenopausal women with previous CAD

To find out to what extent cholesterol metabolism is affected

Gylling et al. 1997 3

Methods

First study group:Double-blind, randomized, cross-over study

N=22, postmenopausal women with previous CAD, NOT treated with lipid-lowering medication, mean LDL-C 3,85 mmol/L

Run-in home diet • 7 weeks of sitostanol ester margarine (3 g) or

placebo (rapeseed oil margarine) Second study group:

open labelN=10, simvastatin users consumed sitostanol ester margarine for 12 weeks

Outcome measures: serum lipids & sterols, dietary fatty acid intake and cholesterol metabolism

Gylling et al. 1997 44

Plant stanol ester effectively reduced serum total and LDL cholesterol in CAD patients

Chan

ge (%

) ver

sus

hom

e di

et

Total cholesterol LDL cholesterol

SIGNIFICANT CHOLESTEROL REDUCTION IN PATIENTS WITH CAD

*Plant stanol ester specific effect

Control margarine

Plant stanol ester margarine (3 g/d plant stanol)

Change in TC and LDL-C plant stanol ester vs. control p<0.05

Gylling et al. 1997 5

Effect of sitostanol ester margarine on cholesterol absorption in postmenopausal women with previous myocardial infarction

5

Total cholesterol absorbedmg/kg/d

Dietary cholesterol absorbedmg/kg/d

Biliary cholesterol absorbed mg/kg/d

7,17 ± 0,52

1,35 ± 0,15

5,22 ± 0,45

7,37 ± 0,62

1,53 ± 0,15

5,84 ± 0,53

4,03 ± 0,27 *†-45,3 %

0,76 ± 0,11 *†-50,3 %

3,27 ± 0,20 *†-44,0%

Rapeseed oil margarineHome diet

Rapeseed oil margarine +

sitostanol ester

* P<0,05 from home diet † P<0,05 from margarine diet

Gylling et al. 1997 66

Cholesterol absorption (mg/day) in postmenopausal women with coronary artery disease *

Home diet

Control margarine

Plant stanol ester margarine (3 g/d plant stanol)

Dietary cholesterol absorbed

Bilary cholesterol absorbed

Total amount of cholesterol absorbed

mg

With plant stanol ester: ~ 230 mg less cholesterol absorbed versus home diet

Cholesterol absorption (mg/day) in postmenopausal women with coronary artery disease

Gylling et al. 1997 7

Serum lipids before and at the end of three month sitostanol ester margarine period of coronary women (n=10) on Simvastin

7

Cholesterol, total

LDL Cholesterol

4,38 ± 0,35

2,37 ± 0,35

4,94 ± 0,43

2,86 ± 0,44

-11,1 ± 3,2*

-16,3 ± 5,0*

EndBefore % ChangeSerum Lipid

Pre-simvastatin values: Total cholesterol: 6,45±0,17 mmol/L,LDL cholesterol: 4,42±0,35 mmol/LMean±SE. * P<0,05 from before

Gylling et al. 1997 8

Conclusions

Plant stanol ester reduces the absorption of both dietary and biliary cholesterol• Effective even in a diet containing close to no

cholesterol

About one third of the women were able to reduce their LDL-C to recommended level with the help of plant stanol ester margarine

9

Thank You!