Abstract
Atherosclerotic cardiovascular diseases (ASCVDs) cause every fifth death worldwide. However, it is possible to prevent the progression of ASCVDs by reducing circulating concentrations of low-density lipoprotein cholesterol (LDL-C). Recent large meta-analyses demonstrated that by reducing the dietary intake of saturated fat and cholesterol, it is possible to reduce the risk of ASCVD events. Plant stanols, as fatty-acid esters, were developed as a dietary adjunct to reduce LDL-C levels as part of a heart-healthy diet. They reduce cholesterol absorption so that less cholesterol is transported to the liver, and the expression of LDL receptors is upregulated. Ultimately, LDL-C concentrations are reduced on average by 9–12% by consuming 2–3 g of plant stanol esters per day. In this review, we discuss recent information regarding the prevention of ASCVDs with a focus on dietary means. We also present new estimates on the effect of plant stanol ester consumption on LDL-C levels and the risk of ASCVD events. Plant stanol esters as part of a heart-healthy diet plausibly offer a means to reduce the risk of ASCVD events at a population level. This approach is not only appropriate for subjects with a high risk of ASCVD, but also for subjects at an apparently lower risk to prevent subclinical atherosclerosis.
Highlights
Cardiovascular diseases (CVDs) are still the most frequent cause of death worldwide [1].Two-thirds of CVD deaths are caused by atherosclerotic cardiovascular diseases (ASCVDs), such as coronary artery disease (CAD), ischemic stroke, and peripheral artery disease
We present new estimates on the effect of plant stanol ester consumption on low-density lipoprotein cholesterol (LDL-C) levels and the risk of ASCVD events
The reduction of LDL-C concentrations is the primary target to reduce the risk of ASCVD events
Summary
Cardiovascular diseases (CVDs) are still the most frequent cause of death worldwide [1]. Two-thirds of CVD deaths are caused by atherosclerotic cardiovascular diseases (ASCVDs), such as coronary artery disease (CAD), ischemic stroke, and peripheral artery disease. ASCVD causes more than one-fifth of all deaths worldwide [1]. Inhibitors enable effective control of LDL-C in hypercholesterolaemic patients with ASCVD, dietary and other lifestyle measures will remain the backbone of LDL-C control at the population level [3]. We compile and discuss recent information regarding the prevention of ASCVD with a focus on dietary means, especially the intake of dietary fat, cholesterol, and plant stanols, one type of phytosterols. We present new estimations to predict the effect of plant stanol ester consumption on LDL-C levels and on the risk of ASCVD events.
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