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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

1
Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
2
Center for Life-Course Health Research, University of Oulu, 90570 Oulu, Finland
3
Wihuri Research Institute, 00290 Helsinki, Finland
4
Heart and Lung Center, Cardiology, Helsinki University Hospital, University of Helsinki, 00029, Helsinki, Finland
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(8), 2346; https://doi.org/10.3390/nu12082346
Received: 7 July 2020 / Revised: 28 July 2020 / Accepted: 4 August 2020 / Published: 6 August 2020
(This article belongs to the Special Issue Health Benefits of Plant Sterols)
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. View Full-Text
Keywords: atherosclerosis; cardiovascular disease; cholesterol; lipoprotein; nutrition; plant stanol; risk reduction atherosclerosis; cardiovascular disease; cholesterol; lipoprotein; nutrition; plant stanol; risk reduction
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Gylling, H.; Strandberg, T.E.; Kovanen, P.T.; Simonen, P. 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 2020, 12, 2346.

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