Reducing the risk of atherosclerotic cardiovascular diseases by dietary means: anything new?

Atherosclerotic cardiovascular diseases (ASCVDs) cause more deaths than any other disease group worldwide. However, it is possible to prevent the progression of atherosclerosis and the risk of ASCVD events by reducing the circulating concentrations of low-density-lipoprotein cholesterol (LDL-C). Large meta-analyses have demonstrated that decreasing the dietary intake of saturated fat and cholesterol can reduce the risk of ASCVD events. Here, we discuss the recent information regarding the prevention of subclinical atherosclerosis, ASCVD, and the risk of ASCVD events with a focus on dietary means. Plant stanols as fatty-acid esters were developed as a dietary adjunct to reduce LDL-C levels as part of a heart-healthy diet. They reduce cholesterol absorption so that less cholesterol is transported to the liver, the expression of LDL receptors is upregulated, and LDL-C concentrations are reduced on average by 0.40 mmol/L (12%) by consuming 3 g of plant stanols as esters/day. Using the equations of Keys, Anderson, and Grande, and the FINRISKI-counter equation, we also demonstrate that a heart-healthy diet combined with plant stanol ester consumption plausibly reduces the risk of coronary artery disease events by 23%. Thus, plant stanol esters as part of a heart-healthy diet seem to offer an effective means to reduce the risk of ASCVD events both at a population level and for subjects with different risk levels of ASCVD, when needed, in combination with statins.