Intended for healthcare professionals

Rapid response to:

Education And Debate

Plant sterol and stanol margarines and health

BMJ 2000; 320 doi: (Published 25 March 2000) Cite this as: BMJ 2000;320:861

Rapid Response:

Plant sterols: unproved effects on health

Dr. Law pleads for an introduction of plant sterol and stanol
margarines into human food consumption arguing that these sterols lower
the serum cholesterol concentration and therefore also the morbidity and
mortality of ischaemic heart disease.1 This is wishful thinking only.
Before the statin era the same assumption gave rise to a host of trials
using dietary manipulations and/or a variety of drugs, but although these
trials lowered the cholesterol concentration, neither coronary or total
mortality was changed.2 A beneficial effect has been achieved with the
statins, but it was independent on the degree of cholesterol lowering;
coronary morbidity and mortality was lowered whether cholesterol was
lowered only a little or whether it was lowered very much, indicating that
the statins have other, more important effects than cholesterol lowering.3
4 Possibly, plant sterols may have beneficial effects also, but before
this has been proved in controlled, randomised and double-blind trials it
seems prudent to avoid a general usage of an unnatural food with
unfavourable effects on the absorption of antioxidant vitamins and the
flavour of the food.

1. Law M. Plant sterol and stanol margarines and health. BMJ 2000;
320: 861-4.

2. Ravnskov U. Cholesterol lowering trials in coronary heart disease:
frequency of citation and outcome. BMJ 1992; 305: 15-9.

3. West of Scotland Coronary Prevention Study Group. Influence of
pravastatin and plasma lipids on clinical events in the West of Scotland
Coronary Prevention Study (WOSCOPS). Circulation 1998; 97: 1440-5.

4. Sacks FM, Moyé LA, Davis BR et al. Relationship between plasma LDL
concentrations during treatment with pravastatin and recurrent coronary
events in the cholesterol and recurrent events trial. Circulation 1998;
97: 1446-52.

Competing interests: No competing interests

13 April 2000
Uffe Ravnskov
private practitioner; independent researcher
Råbygatan 2, S-22361 Lund Sweden