Cholesterol-lowering effects of a stanol- ester containing low-fat margarine used in conjunction with a strict lipid-lowering diet Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.

Page 2 of 9 *DALY; disability-adjusted life years  Therapeutic lifestyle changes like low cholesterol diet are a recommended way to reduce chronic heart disease risk factors in patients with mild hypercholesterolaemia  The aim of the study was to investigate a possible additional cholesterol lowering effect when a plant stanol ester containing margarine was added to a cholesterol lowering diet Rationale Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.

Page 3 of 9  Controlled and randomised study  Stanol 2 g/d Design Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.

Page 4 of 9 Patient population Inclusion criteria:  Serum cholesterol >194 mg/dl  LDL >116 mg/dl Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.

Page 5 of 9 Patient population Exclusion criteria:  Serum cholesterol >330 mg/dl  Body mass index >30  During the 3 months before the study  Body weight changes of >4 kg  Treatment with lipid lowering drugs  Specific diets or food allergies that would interfere with the test diet  Diseases affecting lipid metabolism (renal, thyroid or liver disorders, diabetes mellitus on treatment or increased fasting blood glucose level)  Alcohol overconsumption  Persons who, because of language barriers, were considered unable to adhere to the protocol Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.

Page 6 of 9 Protocol Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.

Page 7 of 9 Results Figure 1. Combination of plant stanol and a strict lipid lowering diet showed a significant additional LDL lowering effect over the strict diet alone (p=0.0158). Usual diet + test margarine Test diet + control margarine Test diet + test margarine Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.

Page 8 of 9 *DALY; disability-adjusted life years  Dietary plant stanol esters seem to be a safe and effective dietary tool as part of a cholesterol lowering diet, to lower elevated cholesterol levels also on a population basis Conclusion Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.

Page 9 of 9 *DALY; disability-adjusted life years  Plant stanol ester containing functional foods provide additional cholesterol lowering effects on top of traditional cholesterol lowering diet Editor’s note Andersson A et al. Eur Heart J Suppl. 1999;1 Suppl S:S80-90.