The first margarine spread capable of reducing cholesterol concentrations was launched in the United Kingdom last week, giving a new twist to the concept of healthy eating. The margarine spread—Benecol—contains stanol esters derived from wood pulp, which reduce the amount of cholesterol absorbed by the gastro-intestinal system.
A year long study carried out in Finland has shown that the spread can reduce concentrations of total cholesterol by up to 10%and of low density lipoprotein cholesterol by up to 14%if eaten as part of a low fat, low cholesterol diet (New England Journal of Medicine 1995;333:1308-12). Using the product makes no appreciable difference to concentrations of triglycerides or high density lipoprotein cholesterol.
Subjects taking part in the study consumed around 3 g of stanol ester each day—equivalent to generously spreading three pieces of toast with the margarine. According to Benecol’s marketing company, McNeil Consumer Healthcare Company, the margarine has sold very well since its launch in Finland three years ago, and an estimated 140000 people are now consuming it daily.
The cholesterol lowering effect seen in trials has been repeated in more widespread use of the margarine in Finland, although the population is generally well educated about risk factors for coronary heart disease, with strategies such as the North Karelia project having achieved considerable reductions in related mortality.
It is still too early to know if use of Benecol translates into reduced coronary heart disease mortality. But studies using drug treatment and other approaches to lipid lowering have indicated that a 10%reduction in cholesterol translates into a 20%reduction in the risk of coronary disease.
Benecol is likely to be heavily marketed to doctors as well as to the general public—advertisements are already appearing in publications for general practitioners. So what is its place in managing patients at increased risk of coronary heart disease?
Results with the product in Finland suggest that Benecol is most likely to be of value in people with moderately raised cholesterol or who have other risk factors.
Gilbert Thompson, emeritus professor of clinical lipidology at the Imperial College School of Medicine in London, commented: “Benecol will probably be particularly useful for general practitoners to suggest to healthy people who have risk factors for coronary disease, where drug therapy is considered inappropriate. It offers an important adjunct in the dietary approach to the primary prevention of coronary heart disease.”
The only side effect observed with Benecol has been a 10-20%reduction in β carotene.
Unfortunately, the price of Benecol—£2.49 for a 250 g tub—may be too high for many of those most at risk of coronary heart disease: people in lower socioeconomic groups.