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Decreasing the Cholesterol Burden in Heterozygous Familial Hypercholesterolemia Children by Dietary Plant Stanol Esters

by Alpo Vuorio 1,2,* and Petri T. Kovanen 3
1
Mehiläinen Airport Health Centre, 01530 Vantaa, Finland
2
Department of Forensic Medicine, University of Helsinki, 00014 Helsinki, Finland
3
Wihuri Research Institute, 00290 Helsinki, Finland
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(12), 1842; https://doi.org/10.3390/nu10121842
Received: 2 November 2018 / Revised: 20 November 2018 / Accepted: 21 November 2018 / Published: 1 December 2018
(This article belongs to the Special Issue Plant Sterols/Stanols and Human Health)
This review covers the current knowledge about plant stanol esters as a dietary treatment option for heterozygous familial hypercholesterolemia (he-FH) children. The current estimation of the prevalence of he-FH is about one out of 200–250 persons. In this autosomal dominant disease, the concentration of plasma low-density lipoprotein cholesterol (LDL-C) is strongly elevated since birth. Quantitative coronary angiography among he-FH patients has revealed that stenosing atherosclerotic plaques start to develop in he-FH males in their twenties and in he-FH females in their thirties, and that the magnitude of the plaque burden predicts future coronary events. The cumulative exposure of coronary arteries to the lifelong LDL-C elevation can be estimated by calculating the LDL-C burden (LDL-C level × years), and it can also be used to demonstrate the usefulness of dietary stanol ester treatment. Thus, when compared with untreated he-FH patients, the LDL-C burden of using statin from the age of 10 is 15% less, and if he-FH patients starts to use dietary stanol from six years onwards and a combination of statin and dietary stanol from 10 years onwards, the LDL-C burden is 21% less compared to non-treated he-FH patients. We consider dietary stanol treatment of he-FH children as a part of the LDL-C-lowering treatment package as safe and cost-effective, and particularly applicable for the family-centered care of the entire he-FH families. View Full-Text
Keywords: phytosterol; stanol; diet; familial hypercholesterolemia; coronary heart disease; hypercholesterolemia; children; family; atherosclerosis; low-density cholesterol phytosterol; stanol; diet; familial hypercholesterolemia; coronary heart disease; hypercholesterolemia; children; family; atherosclerosis; low-density cholesterol
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Vuorio, A.; Kovanen, P.T. Decreasing the Cholesterol Burden in Heterozygous Familial Hypercholesterolemia Children by Dietary Plant Stanol Esters. Nutrients 2018, 10, 1842.

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