Plant stanol ester in the treatment and prevention guidelines 0

International Atherosclerosis Society, 2013 American Diabetes Association, 2013 European Atherosclerosis Society, 2013 European Society of Cardiology, 2012 National Heart, Lung, and Blood Institute & National Institutes of Health & American Academy of Pediatrics, 2011 European Society of Cardiology & European Atherosclerosis Society, 2011 The Australian Heart Foundation, 2009 American Academy of Pediatrics, 2008 American Diabetes Association & American College of Cardiology, 2008 American Heart Association & American College of Cardiology, 2006 Joint British Societies, 2005 International Atherosclerosis Society, 2005 Joint WHO/FAO Expert Consultation, 2003 Expert bodies recommend the use of plant stanols 1

ESC/EAS Guidelines for the management of dyslipidemias, 2011 The magnitude of the effect of functional foods enriched with phytosterols is graded highest possible and the level of evidence is of class ’A’ ’Based on the available evidence, foods enriched with phytosterols (1-2 g/day) may be considered for individuals with elevated TC and LDL-C values in whom the total CV risk assessment does not justify the use of cholesterol-lowering drugs.’ ’Functional food containing phytosterols additionally reduce LDL-C levels by up to 5-10% in patients taking stable dose of a statin, and this combination is also well tolerated and safe.’ The Task Force for the management of dyslipidemias of the European Society of cardiology (ESC) and the European Atherosclerosis Society (EAS). ESC/EAS Guidelines for the management of dyslipidemias. Atherosclerosis 2011; 217S1: S1-S44. 34

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) Functional foods containing phytosterols (plant sterols and stanols) are effective in lowering LDL cholesterol levels by on average 10%, when consumed in amounts of 2 g/day. The cholesterol-lowering effect is additional to that obtained with a low- fat diet or use of statins. Some recent research indicates that, especially for stanols, further cholesterol reduction can be obtained with higher doses. 3 The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012).

IAS Position Paper: Global Recommendations for the Management of Dyslipidemia, 2013 ‘Consider using plant sterols/stanols (2 g/day) as a dietary adjunct [--] to further lower LDL-C levels.’ ‘if plant sterols/stanols are available, they are a useful adjunct to lowering of LDL-C by dietary means.‘ 4

US NHLBI Expert Panel Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, 2011 Plant stanol ester can safely enhance LDL-C lowering effects in children with FH Especially children with primary elevations of LDL-C who do not achieve LDL-C goals with dietary treatment alone may benefit from plant stanol ester. Such an approach may lower LDL-C sufficiently to avoid the necessity of drug treatment. Plant stanols (up to 2 g/d) can be used after age 2 years in children with familial hypercholesterolemia. Short-term studies show no harmful effects in healthy children. 5 National Heart, Lung, and Blood Institute & National Institutes of Health & American Academy of Pediatrics, 2011.

Nutrition Recommendations and Interventions for Diabetes Plant stanols and sterol are considered as an additional therapeutic option for LDL cholesterol lowering complementing the standard recommendations of limiting saturated and trans fats and dietary cholesterol and increasing soluble fiber consumption. ’in individuals with type 2 diabetes, intake of 2 g/day plant sterols and stanols has been shown to lower plasma total and LDL cholesterol’ 6 American Diabetes Association, 2008 American Diabetes Association & American College of Cardiology, 2008 American Diabetes Association, 2013