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!