Stanol ester margarine is a safe and effective hypolipidaemic treatment in children and adults with heterozygous familial hyperlipidaemia (FH), say Dr Alpo Vuorio and colleagues (department of medicine, University of Helsinki, Finland).
Heterozygous FH patients have serum low density lipoprotein (LDL) cholesterol levels two or three times higher than those of the normal population, even at birth, and an increased risk of coronary heart disease.
Dr Vuorio and colleagues report a 12-week study in 28 heterozygous FH patients (four adults and 24 children aged three to 13 years) and 16 healthy patients (Arteriosclerosis, Thrombosis and Vascular Biology 2000;20:500). Each subject replaced a part of their normal dietary fat with 25g of 80 per cent rape seed oil margarine containing stanol esters. In addition, 12 heterozygous FH patients who were taking simvastatin were given stanol ester margarine, as the authors wished to evaluate any additional effect that the margarine might have.
Serum total cholesterol and LDL cholesterol levels were reduced by 14 and 18 per cent, respectively, in the children. In the adults and healthy volunteers, LDL cholesterol was decreased by 11 and 12 per cent, respectively. The reduction in serum LDL cholesterol was greater (20 per cent) in the group that was also taking simvastatin and, according to the authors, this was independent of the simvastatin dose. In all of the groups, HDL cholesterol and triglyceride levels remained unchanged. No side effects were experienced, the authors say. Benecol, a stanol ester margarine and cream cheese-type spread, was launched in the UK in March, 1999 (PJ 1999;262:424).
Dr Jonathan Morrell (chairman, health care section, British Hyperlipidaemia Association) told The Journal on February 16 that studies had established the efficacy of stanol margarines in a range of lipid disorders and that their effects were additional to those of statins because they had a different mode of action. The typical reduction in LDL cholesterol seen with the margarines was in the order of 10 per cent, which might make the difference between a patient having to take a drug or not, or between achieving or not achieving a desired cholesterol level, he added.