University of Oulu

Gylling, H., Strandberg, T. E., Kovanen, P. T., & Simonen, P. (2020). Lowering Low-Density Lipoprotein Cholesterol Concentration with Plant Stanol Esters to Reduce the Risk of Atherosclerotic Cardiovascular Disease Events at a Population Level: A Critical Discussion. Nutrients, 12(8), 2346. doi:10.3390/nu12082346

Lowering low-density lipoprotein cholesterol concentration with plant stanol esters to reduce the risk of atherosclerotic cardiovascular disease events at a population level : a critical discussion

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Author: Gylling, Helena1; Strandberg, Timo E.1,2; Kovanen, Petri T.3;
Organizations: 1Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
2Center for Life-Course Health Research, University of Oulu, 90570 Oulu, Finland
3Wihuri Research Institute, 00290 Helsinki, Finland
4Heart and Lung Center, Cardiology, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Multidisciplinary Digital Publishing Institute, 2020
Publish Date: 2020-09-08


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.

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Series: Nutrients
ISSN: 2072-6643
ISSN-E: 2072-6643
ISSN-L: 2072-6643
Volume: 12
Issue: 8
Article number: 2346
DOI: 10.3390/nu12082346
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Open access funding provided by University of Helsinki.
Copyright information: © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (