News Release

Special margarine cuts cholesterol levels in children with genetic risk of early heart disease

Peer-Reviewed Publication

American Heart Association

DALLAS, Feb. 11 - A special margarine significantly reduced blood cholesterol levels in children with a genetic risk for early heart disease, according to a study in the February issue of Arteriosclerosis, Thrombosis, and Vascular Biology: Journal of the American Heart Association.

The children in the study all had a condition called heterozygous familial hypercholesterolemia (FH), a common inherited disease that affects an estimated one in 500 people, says lead author of the study Alpo F. Vuorio, M.D., Ph.D., a post-doctoral fellow at the Finnish Academy, department of medicine, University of Helsinki, Finland.

Individuals with the FH gene cannot properly rid their bodies of low-density lipoprotein (LDL), the "bad" cholesterol, which is strongly linked to the development of heart disease.

Two-thirds of untreated men born with one FH gene develop heart disease by age 40 to 60. In the much rarer cases where people inherit two FH genes, cholesterol levels are so high that the arteries begin to get blocked in the womb, and heart attacks are likely to occur before age 20.

Since atherosclerosis, the disease process that underlies heart disease, is a progressive disease and begins in childhood in families with FH, it should be treated as early as possible, Vuorio says. However, the drugs most commonly prescribed to treat the condition - bile acid-binding resins - have several unpleasant side effects such as nausea, which make children less likely to comply with their treatment. These drugs may also raise the levels of triglycerides, another fat in blood that is strongly linked to heart disease. The researchers followed 19 families from the North Karelia area of Eastern Finland who carried the FH gene, including 24 children and four adults with the gene and 16 relatives who do not carry the mutation. None were taking any cholesterol-lowering drugs.

The subjects ate a special margarine containing stanol esters, which are derived from pine pulp, for three months.

After three months, the researchers found that levels of LDL cholesterol dropped 18 percent in the children, 11 percent in the FH family members and 12 percent in the family members without the FH trait.

Dietary stanol ester margarine proved to be an effective cholesterol-lowering treatment among children ages three through 13, as well as in 12 adults participating in a separate study who were also taking statin drugs to lower their LDL cholesterol levels, Vuorio says. He adds that the margarine and the drugs seem to complement each other - the margarine blocks the absorption of cholesterol and the statins block a key enzyme the body needs to make more cholesterol.

"Finnish North Karelia represents a high-risk coronary heart disease area, probably due to a combination of unfavorable dietary habits and cholesterol-raising genes. This situation led us to conduct the first evaluation of a family therapy to lower cholesterol. We found that even family members who do not have FH decreased their LDL cholesterol levels by about 12 percent by eating this margarine," Vuorio says.

Although only one FH child's LDL cholesterol fell into the normal range, the results are significant because the stanol ester margarine appears to be safe, effective and easy to use, he says.

"Very good results have been achieved with this margarine in long-term follow-up studies of adults whose high cholesterol levels were not as severe as in FH," says Vuorio.

It is important to note that the people consuming the margarine in the study already had elevated levels of cholesterol because of a genetic abnormality. The American Heart Association recommends that individuals with elevated cholesterol levels who consume the new cholesterol-lowering margarines do so under the guidance of a physician. These individuals should choose foods low in saturated fat and cholesterol such as fruits, vegetables, whole grains and low-fat dairy products.

The American Heart Association does not recommend the cholesterol-lowering margarines for children or adults who have normal cholesterol levels. Co-authors are Helena Gylling, M.D., Ph.D.; Hannu Turtola, M.D.; Kimmo Kontula, M.D., Ph.D.; Pirjo Ketonen, Ms.C; and Tatu A. Miettinen, M.D., Ph.D.

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