Plant stanol esters provide a novel approach to lowering plasma low-density lipoprotein
(LDL) cholesterol by dietary means. Their development was preceded by a long
period of research into the cholesterol-lowering properties of plant sterols and,
recently, plant stanols. Both classes of compound competitively inhibit the absorption
of cholesterol and thus lower its level in plasma. Initial impressions were that stanols
were more effective and safer than sterols, but the negative outcome of a study led to
the recognition that the lipid solubility of free stanols was very limited. This was
overcome by esterifying them with fatty acids, with the resultant stanol esters being
freely soluble in fat spreads. This led to the launch of Benecol (margarine; Raisio
Group, Raisio, Finland) in 1995. The coincident publication of the year-long North
Karelia study conclusively demonstrated the long-term LDL-lowering efficacy of
plant stanol esters. Variables that might influence the efficacy of stanol esters include
dose, frequency of administration