Stanol esters as a dietary adjunct to cholesterol-lowering therapies

Results of clinical trials confirm the efficacy and safety of statins for cholesterol lowering and open the door to new approaches to reducing low-density lipoprotein (LDL) cholesterol concentrations. Statins inhibit cholesterol synthesis, reduce hepatic cholesterol, enhance expression of LDL receptors and lower serum LDL cholesterol levels. Another way to increase LDL receptors is to inhibit cholesterol absorption, which reduces serum LDL cholesterol about one-half of that obtained by statin therapy. Although different agents inhibit cholesterol absorption (e.g. Olestra, neomycin, surformer [AOMA], acyl coenzyme A acyltransferase inhibitors, microsomal lipid transfer protein inhibitors, plant sterols and stanols), the latter are the most practical for widespread use. Stanols act entirely within the gastrointestinal tract, a feature that greatly increases their safety. Consequently, they are a useful adjunct to dietary therapy for LDL cholesterol lowering. Stanol esters have other characteristics of an ideal dietary adjunct for cholesterol lowering. They are well tolerated and seemingly are free from side-effects. Their potential utility as a dietary adjunct for lowering LDL cholesterol is considered in the context of preventive strategies, both secondary and short- and long-term primary prevention, in high-risk and low-risk persons.