Heart disease is a leading cause of illness and death in the United States and other developed countries. The National Heart, Lung, and Blood Institute launched the National Cholesterol Education Program (NCEP) in 1985. The goal of NCEP is contribute to reducing illness and death from coronary heart disease (CHD) in the United States by reducing the percent of Americans with high blood cholesterol. Through educational efforts directed at health professionals and the public, the NCEP aims to raise awareness and understanding about high blood cholesterol as a risk factor in CHD and the benefits of lowering cholesterol levels as a means of preventing CHD.

In 2001, NCEP published LDL cholesterol targets for individuals in various risk categories. NCEP identified 5 risk categories which modify LDL cholesterol targets; these are cigarette smoking, hypertension, low HDL cholesterol, a family history of premature coronary heart disease, and age. A table from the 2001 NCEP summary document is shown below.

Table 1: LDL Cholesterol Goals, Ranges for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories

Plant Sterols and Stanols as Part of Therapeutic Lifestyle Changes

As noted in Table 1, NCEP has recommended Therapeutic Lifestyle changes (TLC) as part of bringing LDL cholesterol to target levels:

Plant sterols and stanols lower blood LDL cholesterol by blocking the absorption of cholesterol from the intestine. Soluble fibers, such as oat bran beta-glucans lower LDL cholesterol (Theuwissen et al 2008). Beta-glucans interfere with the absorption of cholesterol and at the same time interfere with the re-absorption of bile acids (Clifton 2009). The reduction in absorption of bile acids partly shifts liver metabolism from cholesterol synthesis to bile acid synthesis. Soluble fibers are additive to plant sterols and stanols in lowering LDL cholesterol (Theuwissen et al 2007). By combining changes in the diet with weight reduction and plant sterols and stanols it is possible to reduce LDL cholesterol by 25-30%. See Table 2 which provides an estimate of LDL eduction that can be obtained with lifestyle changes.

Table 2: NCEP Recommendations for Maximal Dietary Therapy for LDL-C Reduction

Dietary Modification Recommendation Approximate LDL-C Reduction (%)
Saturated Fat Reduction Reduce saturated fat to <7% of calories 8-10
Dietary cholesterol reduction Reduce dietary cholesterol to3-5
Plant stanols/sterols Add plant stanols/sterols up to 2 g/day 6-10
Dietary fiber Viscous fiber 5-10 g/day 3-5
Weight reduction 10 lb (4.5 kg) weight loss 5-8
Total LDL-C lowering 25-30