1. 23.08.2011 Copyright® Raisio Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine Gylling H et al., Circulation, 1997

2. Gylling et al. 19972 Objectives To investigate the serum cholesterol lowering effect of sitostanol ester margarine alone and in combination with statins in postmenopausal women with previous CAD To find out to what extent cholesterol metabolism is affected

3. Gylling et al. 19973 Methods First study group: Double-blind, randomized, cross-over study N=22, postmenopausal women with previous CAD, NOT treated with lipid-lowering medication, mean LDL-C 3,85 mmol/L Run-in home diet 7 weeks of sitostanol ester margarine (3 g) or placebo (rapeseed oil margarine) Second study group: open label N=10, simvastatin users consumed sitostanol ester margarine for 12 weeks Outcome measures: serum lipids & sterols, dietary fatty acid intake and cholesterol metabolism

4. Gylling et al. 199744 Plant stanol ester effectively reduced serum total and LDL cholesterol in CAD patients Change (%) versus home diet Total cholesterol LDL cholesterol SIGNIFICANT CHOLESTEROL REDUCTION IN PATIENTS WITH CAD * Plant stanol ester specific effect Control margarine Plant stanol ester margarine (3 g/d plant stanol) Change in TC and LDL-C plant stanol ester vs. control p<0.05

5. Gylling et al. 19975 Effect of sitostanol ester margarine on cholesterol absorption in postmenopausal women with previous myocardial infarction 5 Total cholesterol absorbed mg/kg/d Dietary cholesterol absorbed mg/kg/d Biliary cholesterol absorbed mg/kg/d 7,17 ± 0,52 1,35 ± 0,15 5,22 ± 0,45 7,37 ± 0,62 1,53 ± 0,15 5,84 ± 0,53 4,03 ± 0,27 *† -45,3 % 0,76 ± 0,11 *† -50,3 % 3,27 ± 0,20 *† -44,0% Rapeseed oil margarine Home diet Rapeseed oil margarine + sitostanol ester * P<0,05 from home diet † P<0,05 from margarine diet

6. Gylling et al. 199766 Cholesterol absorption (mg/day) in postmenopausal women with coronary artery disease * Home diet Control margarine Plant stanol ester margarine (3 g/d plant stanol) Dietary cholesterol absorbed Bilary cholesterol absorbed Total amount of cholesterol absorbed mg With plant stanol ester: ~ 230 mg less cholesterol absorbed versus home diet Cholesterol absorption (mg/day) in postmenopausal women with coronary artery disease

7. Gylling et al. 19977 Serum lipids before and at the end of three month sitostanol ester margarine period of coronary women (n=10) on Simvastin 7 Cholesterol, total LDL Cholesterol 4,38 ± 0,35 2,37 ± 0,35 4,94 ± 0,43 2,86 ± 0,44 -11,1 ± 3,2* -16,3 ± 5,0* End Before % Change Serum Lipid Pre-simvastatin values: Total cholesterol: 6,45±0,17 mmol/L, LDL cholesterol: 4,42±0,35 mmol/L Mean±SE. * P<0,05 from before

8. Gylling et al. 19978 Conclusions Plant stanol ester reduces the absorption of both dietary and biliary cholesterol Effective even in a diet containing close to no cholesterol About one third of the women were able to reduce their LDL-C to recommended level with the help of plant stanol ester margarine

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