Copyright® Raisio A comparison of the LDL-cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: Results of a meta-analysis of randomized, placebo-controlled trials Kathy Musa-Veloso, Theresa H. Poon, Julie Ann Elliot, Catherine Chung. Prostaglandins, Leukotrienes and Essential Fatty Acids 2011; 85: 9–28. Kathy Musa-Veloso, Theresa H. Poon. Prostaglandins, Leukotrienes and Essential Fatty Acids doi: /j.plefa

2 Background: Efficacy of plant stanols vs. plant sterols Until now, scientific consensus has largely concluded that the cholesterol-lowering effects of plant stanols and plant sterols are equal Higher than recommended daily intakes have been thought to bring no additional benefit (e.g. Katan MB et al. Mayo Clinic Proc 2003; 78: )

3 Background: Efficacy of plant stanols vs. plant sterols In a meta-analysis published in 2009, the maximal LDL- cholesterol reduction for the pooled results of plant stanols and plant sterols was 12.3%. (Demonty et al. The Journal of Nutrition 2009;139: ) When the efficacy of plant stanols and plant sterols was analysed separately, there was a non-significant 6.7% difference in their maximal relative LDL-CH lowering. In 2010, two studies with high daily intakes (up to 9 g) of plant stanols indicated that the cholesterol-lowering effect of plant stanols was enhanced when its intake exceeded the currently recommended 2 g/d. (Mensink et al. Am J Clin Nutr 2010; 92: Gylling et al. Clin Nutr 2010; 29: )

Significantly better maximal efficacy with Plant stanol ester (Musa-Veloso et al. 2011a, 2011b) The estimated maximal LDL-cholesterol reduction was 18.3% for plant stanol ester. The estimated maximal LDL-cholesterol reduction was 10.3% for plant sterol ester.

5 Conclusions (Musa-Veloso et al. 2011a, 2011b) The maximal LDL cholesterol reduction achievable with plant stanol ester was significantly better compared to plant sterol ester At intakes in excess of the recommended 2 g/day, plant stanols are associated with additional and dose-dependent reductions in LDL cholesterol, possibly resulting in further reductions in the risk of CHD No such evidence for a dose- response with plant sterols was found

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