Original paper

Effects of plant stanol or sterol-enriched diets on lipid profiles in patients treated with statins: systematic review and meta-analysis

  • Plant stanols/sterols work in a different way to statins and can help people who take statin medication achieve further cholesterol reduction
  • Current expert advice supports a lower the better strategy for blood cholesterol
  • Healthy diet is an important factor for reducing cardiovascular disease risk

A new systematic review of the current literature combined with a detailed meta-analysis has further confirmed that plant stanol/sterol-containing foods can add additional cholesterol lowering benefits for people already on statin therapy.

Data from a total of 500 participants was analysed from 15 suitable randomized controlled trials (RCTs) published between 1996 and December 2015. Intervention lasted from 4 to 85 weeks with a median intervention of 6 weeks. Plant sterol/stanol intake ranged from 1.8 to 6 g/d with a median intake of 2.5 g/d.

The results showed that in addition to the cholesterol lowering effect of the statin a further 0.30 mmol/l reduction in both total cholesterol and low-density lipoprotein (LDL) cholesterol could be achieved with foods containing added plant sterols/stanols. High-density lipoprotein (HDL) and triglycerides remained the same.

Overall, the results of this new meta-analysis are fully comparable to the previously reported findings from the meta-analysis by Scholle et al (Scholle et al, J Am Coll Nutr, 2009).

Plant sterols/stanols lower LDL-cholesterol by inhibiting intestinal cholesterol absorption, while statins lower serum LDL-cholesterol by inhibiting cholesterol synthesis, mainly in the liver. Because plant sterols/stanols and statins work through different, complementary mechanisms, this leads to the described additive beneficial cholesterol-lowering effect.

In line with the “lower the better” strategy advocated by leading health authorities such as the American College of Cardiology and the American Heart Association (ACC-AHA) and the European Atherosclerosis Society (EAS), such extra reduction in cholesterol may further reduce the risk of cardiovascular disease (CVD).

This meta-analysis gives important evidence of an additional benefit in terms of cholesterol reduction that can be gained from using plant sterols/stanols in combination with statin medication. This will also be useful in treating patients who fail to achieve LDL-C targets or are statin intolerant, a target population for whom plant sterols/stanols is considered as described in the EAS consensus panel paper (Gylling et al Atheroscleosis 2014). This is in keeping with current guidelines that place diet and lifestyle modification at the cornerstone of CVD risk reduction.