An Update on Statin Alternatives and Adjuncts

Matthew J Sorrentino


Clin Lipidology. 2012;7(6):721-730. 

In This Article

Plant Stanols & Sterols

Foods that contain plant stanol or sterols can lower cholesterol levels. Over 40 different phytosterols have been identified with sitosterol, campesterol and stigmasterol the most common in food sources. Stanols are saturated sterols. Foods that are enriched with plant stanols or sterols lower serum cholesterol levels by reducing intestinal absorption of cholesterol. The stanols and sterols displace cholesterol from micelles in the intestine and may interact with an enterocyte pathway that pumps sterols out of the cell, therefore preventing uptake of the cholesterol-containing micelles.[19] A summary of 55 randomized placebo-controlled trials showed that approximately 2 g/day of plant stanols and sterols reduces LDL-C by approximately 10%.[20] The reduction in LDL-C can be additive to a low-saturated fat diet or medical therapy. The efficacy in LDL-C reduction seems to be the same if stanols and sterols are taken once a day or in divided servings.[20] The addition of sterols and stanols to statin therapy can achieve an additive LDL-lowering effect. A study of 167 individuals on statin therapy reported an additional 10% lowering of LDL when a stanol ester margarine was added to the diet.[21]

The addition of nuts to the diet may also help reduce LDL-C levels. Nuts are rich in plant protein, fiber, phytosterols and unsaturated fatty acids. A pooled analysis of 25 nut consumption trials showed that a mean daily consumption of 67 g of nuts reduced LDL-C by 7.4%.[22] The effect of nut consumption was dose related and different types of nuts had a similar efficacy. Walnuts may be particularly helpful because they contain the ω-3 fat, α-linolenic acid that may give an additional benefit in reducing cardiac events. Epidemiologic studies have suggested that a diet high in nuts is associated with lower coronary heart disease events.[23–25]