Cardiovascular diseases (CVD), including heart disease and stroke, is the single leading cause of death in the world. In the UK, 1 in 5 men and 1 in 8 women die from coronary heart disease (CHD), culminating in around 74,000 deaths each year. Often these diseases are the manifestation of atherosclerosis caused by prolonged LDL levels of “bad” cholesterol in the blood. Atherosclerosis is a potentially serious condition where arteries become clogged up by fatty substances known as plaques or atheroma. Atherosclerosis is a major risk factor for many conditions involving the flow of blood. High levels of triglycerides (TGs) in the bloodstream have also been linked to atherosclerosis and, by extension, the risk of heart disease and stroke4.
It is estimated that reducing the UK’s LDL-cholesterol by just 5% would prevent 64,000 cases of CVD and that reducing the population’s LDL-Cholesterol by 1mmol/l has the potential to reduce CHD by 19%5.
Factors that can increase prevalence of dyslipidaemia include genetic predisposition, age, gender and ethnicity, diet and lifestyle. Increasing age increases prevalence in both men and women. Women usually have higher HDL levels pre-menopause, otherwise known as the “good” cholesterol, due to the protective effect of the hormone oestrogen. Unfortunately hormonal changes around the time of the menopause cause HDL levels to drop making women of this age more at risk of dyslipidaemia.
Medical conditions such as an under-active thyroid gland, liver disease, kidney failure or an over-active pituitary gland can also contribute to raised blood cholesterol.
Raised blood cholesterol can increase the risk of CHD and cholesterol rich foods will affect blood cholesterol, but only relatively mildly. This is because blood cholesterol is mainly manufactured by the liver from sources such as saturated fats. Blood cholesterol should not be confused with cholesterol rich foods such as eggs, liver and shellfish which would need to be consumed in large amounts for them to affect lipoprotein concentrations and increased consumption of these foods tends to be counteracted by a reduction in the production of cholesterol in the liver.
For those patients with dyslipidaemia, it is essential for them to consume a diet low in saturated fat and high in insoluble fibre. Eating healthily can help reduce cholesterol levels by between 5% and 15%6.
Recent Cholesterol Treatment Trialists’ (CTT) meta-analyses of data from 170,000 participants in 26 randomized trials suggests a 12% reduction in cardiovascular events per 1 mmol/L decrease in LDL during the first year of treatment, with an additional 25% reduction for each subsequent year (meaning CV event reduction of 22% per 1 mmol/L decrease in LDL).2
Plant stanols and sterols are efficacious in reducing cholesterol. Their mechanisms of action complement and enhance other lifestyle interventions, providing an additional cholesterol lowering benefit to patients adopting other lipid medication strategies including pharmacotherapy.
Plant stanols and sterols also provide an alternative option for primary prevention of those at low/medium CV risk. This is for those who are not eligible or choose not to take statin therapy, or those at high risk and require additional effective lifestyle/dietary modifications to reduce their risk.
Numerous studies have shown the safety and tolerability of plant stanols and sterols – see review of evidence.
There are many ways to reduce cholesterol. Helen Bond, Consultant Dietitian says; "Cholesterol-lowering foods containing plant stanols or sterols, such as Benecol® foods, are one of the most effective foods for lowering cholesterol. Oats, nuts, pulses, soya foods and whole grains are good dietary additions and cutting down on saturated and trans fats is advisable. Shopping for functional foods can be confusing, but when it comes to cholesterol lowering, look out for products containing plant stanols or sterols which are clinically proven, rather than probiotics or prebiotics which have different functions."
Target cholesterol levels
Recent guidance from the National Institute for Health and Care Excellence (NICE) provided a target of 40% cholesterol reduction for those with a 10% or greater 10 year risk of developing cardiovascular disease (CVD).7