REDUCTION OF SERUM-CHOLESTEROL IN POSTMENOPAUSAL WOMEN WITH PREVIOUS MYOCARDIAL-INFARCTION AND CHOLESTEROL MALABSORPTION INDUCED BY DIETARYSITOSTANOL ESTER MARGARINE - WOMEN AND DIETARY SITOSTANOL

Background Reduction of serum cholesterol decreases mortality in prima ry and especially in secondary prevention. We investigated how effecti vely postmenopausal women with a previous myocardial infarction reduce d their serum cholesterol with dietary means by using sitostanol ester rapeseed oil margarine, alone and In combination with statins, and to what extent cholesterol metabolism was affected. Methods and Results The first study group consisted of 22 randomly chosen women with angio graphically documented coronary artery disease. Baseline studies on ho me diet were followed by double-blind, randomized, cross-over studies on margazine without and with sitostanol (3 g/d) ester for 7 weeks in random order. A second group of 10 women on simvastatin consumed sitos tanol ester margarine for 12 weeks. Sitostanol ester margarine lowered serum total cholesterol by 13% (P<.05) and LDL cholesterol by 20% (P< .01). Sitostanol ester margarine reduced total cholesterol in all pati ents, LDL cholesterol <2.6 mmol/L (<100 mg/dL) in 32%, and <3.4 mmol/L (<133 mg/dL) in 73% versus none and 270/c during the home diet (P<.01 for both). Combined with simvastatin, sitostanol still reduced total and LDL cholesterol by 11+/-3% and 16+/-5% (P<.01 for both). Sitostano l reduced absorption (-45%), increased fecal elimination (+45% as neut ral sterols), and stimulated synthesis (+39%) of cholesterol. High cho lestanol and plant sterol (high cholesterol absorption) and low baseli ne precursor sterol proportions (low cholesterol synthesis) predicted high decreases in serum cholesterol. Conclusions Dietary use of sitost anol ester margarine normalizes LDL cholesterol in about one third of women with previous myocardial infarction, especially in those with hi gh baseline absorption and low synthesis of cholesterol, and in combin ation with statins reduces the needed drug dose.