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Diet at the heart of CVD Prevention – an e-learning module

  • A newly updated e-learning module is available to assist healthcare professionals to enable patients to make changes to their diet that will help them reduce their CVD risk
  • World leaders in the field of diet and cardiovascular risk reduction have contributed to this easy to use, practical tool
  • Extra resources to use with patients in the clinic and case studies to facilitate discussion with colleagues make it easy to translate the learning into practice

A newly updated e-learning tutorial can help primary healthcare professionals promote a healthy diet for reducing cardiovascular disease (CVD) risk. Designed and developed in collaboration with the European Atherosclerosis Society (EAS), and world leaders in the field of diet and cardiovascular health the tutorial aims to provide the knowledge required to enable people to make diet and lifestyle changes that will reduce their long-term risk of CVD. The tutorial is endorsed by the EAS.

The second updated version of the tutorial now provides a comprehensive knowledge base about the role different foods and food ingredients play on blood cholesterol management. The easy-to-read sections explain the science behind the foods that can actively reduce cholesterol. The information is presented in a way that makes it accessible not only to health care professionals but also for anyone with a keen interest in this area.

The tutorial has eight different sections covering everything from CVD risk factors, healthy dietary patterns, the role of dietary fats, plant sterols/stanols, dietary fibre and soy protein in dyslipidaemia management, other lifestyle changes for CVD prevention and motivational interviewing.  Videos and diagrams further enhance the overall learning experience.

Case studies are provided with detailed three-step approaches to help clinicians manage common problems; for example, a patient with high CVD risk who is reluctant to start statin medication. A short test can be used to check knowledge levels pre-and post-tutorial. Health care professionals can use this tutorial as part of their revalidation and the knowledge test and / or case studies could be used to help them reflect on their own practice and what changes they may make as a result of their learning. The tutorial can be used by individuals but would also lend itself well to group work and the detailed case studies could be discussed with colleagues.

Another excellent feature of this e-learning tool are the downloadable leaflets such as a foods diary, tips for healthy cooking or a “what should I eat” factsheet. This will help clinicians translate the knowledge gained into practice,

Diet at the heart of CVD prevention version 2.0 is supported by BASF, Raisio and Unilever and is freely available at www.DietattheHeart.com

New EAS Consensus Statement:Causal role of LDL-cholesterol in atherosclerotic cardiovascular disease (ASCVD)

During the 85th EAS congress in Prague, the European Atherosclerosis Society (EAS) announced the publication of a new Consensus Statement, which confirms the causal role of LDL-cholesterol (LDL-C) in the development of atherosclerotic cardiovascular disease.

The consensus panel states that „consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD“. The conclusion of the panel was based on a meta-analysis of more than 200 prospective cohort studies, Mendelian randomization studies and randomized controlled trials, including in total over 2 million participants and more than 20 million person-years of follow-up and over 150 000 cardiovascular events.

With the new consensus statement, it has been confirmed that LDL is not only a biomarker, but a causal factor for CVD. There is a consistent dose-dependent log-linear association between LDL C levels and cardiovascular risk, thus it is of key importance to minimize the cumulative exposure to LDL. Lowering LDL cholesterol starting in early life will be a major opportunity to reduce the lifetime risk of a cardiovascular event.

With this message, the pivotal role of a healthy diet and lifestyle will further move to the focus of early prevention, since it is the only strategy that can be safely implemented on a population level from early life.

For more information on the new EAS Consensus Statement, please visit:

https://academic.oup.com/eurheartj/search-results?page=1&q=Ference%20LDL&fl_SiteID=5375&allJournals=1&SearchSourceType=1

The importance of early lowering of blood cholesterol was highlighted at the 85th Congress of the European Atherosclerosis Society held in Prague, Czech Republic April 23-26, 2017

A key ‘take home’ message from the 85th EAS congress in Prague is that the lower LDL-cholesterol (LDL-C) is, the better, and that the earlier LDL-cholesterol is reduced, the better.

This message was especially emphasized in the session entitled “Progress in understanding the role of nutrition in prevention of atherosclerosis” where the key role of diet (and lifestyle) in LDL-cholesterol lowering was highlighted by three internationally renowned speakers.

Brian A Ference from the USA explained that when blood LDL-cholesterol is kept low throughout life, cardiovascular diseases (CVD) can be prevented much more effectively than when already elevated cholesterol levels are reduced later in life with e.g. cholesterol-lowering medication. Diet plays a crucial role in this early cholesterol management since a healthy diet and lifestyle are the only cholesterol-lowering means that can be safely implemented in a population from early life.

Ursula Schwab from Finland talked about the Mediterranean diet, the best-known heart-healthy dietary pattern recognized for not only improving risk factors for CVD, but also shown to reduce CVD events. Prof Schwab further talked about the Nordic diet, as another heart healthy diet pattern that utilizes healthy food items that are found locally and commonly consumed in Nordic countries.  Both diet patterns are evidence-based and they both emphasize the consumption of vegetables, fruit and berries, vegetable oils and spreads rich in unsaturated fats, fish and lean meat, whole grains, as well as fat-free or low-fat milk products.

Gabrielle Riccardi from Italy reviewed the latest dietary recommendations included in the recent European guidelines on the management of dyslipidemia (2016 EAS/ESC guidelines). He stressed the importance of following a healthy diet for individuals who have normal or mildly elevated cholesterol levels but also for patients who already need cholesterol-lowering medication. Diet and lifestyle advice should always form the foundation of CVD prevention and treatment.  As described in the European guidelines, Prof Riccardi also referred to the impact of specific dietary interventions to reduce LDL-cholesterol levels and in this context recommend foods with added plant stanols or sterols for an additional benefit above a cholesterol-lowering diet.

The 85th EAS congress gathered more than 2400 researchers, clinicians, students, and industry representatives to Prague. The role of a healthy diet and lifestyle in CVD prevention and blood cholesterol management was emphasized throughout the congress, in a plenary session and a special session on Nutraceuticals for early control of dyslipidaemia.  The role that plant sterols and stanols can play as part of a cholesterol-lowering diet was highlighted by several speakers.

For more information about the 85th EAS congress, see http://eas2017.com/

2016 ESC / EAS Guidelines for CVD prevention and dyslipidaemias management published

The European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) have published respectively their 2016 European Guidelines on cardiovascular disease (CVD) prevention in clinical practice (Piepoli et al Eur Heart J 2016; doi:10.1093/eurheartj/ehw106) and their Guidelines for the management of dyslipidaemias (Catapano, Graham, deBacker, Wiklund et al. Eur Heart J 2016 (doi:10.1093/eurheartj/ehw272 and Atherosclerosis 253 (2016) 281e344)

CVD prevention is seen as effective in reducing the impact of CVD whilst the elimination of health risk behaviors would make it possible to prevent at least 80% of CVD. The guidelines consider a lifetime approach and hence people of all ages should be encouraged to adopt or sustain a healthy diet and lifestyle.

The 2016 ESC/EAS guidelines strongly emphasize the importance of CVD prevention both in the general population, by promoting healthy lifestyle behavior, and at  individual level as in those population groups at moderate to high risk of CVD or in patients with established CVD. By tackling  unhealthy lifestyles (e.g. poor-quality diet, physical inactivity, smoking) and by reducing increased levels of risk factors such as elevated blood cholesterol or blood pressure these groups can significantly benefit from reducing the risk of either developing CVD or of aggravating their existing condition.

The Guidelines reemphasize that LDL-cholesterol is the primary treatment target for CVD prevention. This affirms the IPSSAview that it is crucial for people to be aware of their blood cholesterol and in particular their LDL-cholesterol levels, a key risk factor in the development of CVD.  Blood cholesterol can be easily measured through a simple blood test (see also our related Press Release below );

Regarding a healthy diet, the guidelines recommend a diet low in saturated fat with a focus on wholegrain products, vegetables, fruit and fish. Further, the guidelines outline in detail specific diet and lifestyle interventions that reduce LDL-cholesterol levels.

The table below gives a clear picture of the impact lifestyle changes can make on LDL-cholesterol levels where more “+” mean higher efficiency of intervention in LDL-cholesterol lowering, while level of evidence A refers to data derived from multiple randomized clinical trials or meta-analyses and level of evidence B indicates data derived from a single randomized clinical trial or large non-randomized studies.

ldl-table

Regarding functional foods for the treatment of dyslipidaemias, the Guidelines specifically outline the role of foods with added plant sterols and stanols. Specifically, they affirm that the daily consumption of 2 g of plant sterols or stanols can effectively lower LDL-cholesterol by 7-10% in humans.

Furthermore, the Guidelines refer to target groups for whom plant sterols/stanols may be considered such as

  • individuals with high cholesterol levels at intermediate or low global CVD risk who do not qualify for drug therapy
  • as an adjunct to drug therapy in high- and very high-risk patients who fail to achieve LDL-cholesterol goals on statins or are statin intolerant
  • in adults and children (>6 years) with familiar hypercholesterolemia (FH), in line with current guidance

IPSSA has always supported that foods with added plant sterols and stanols as part of a healthy diet and lifestyle can contribute significantly to lowering  LDL-cholesterol, which constitute a major risk factor for CVD.  The cholesterol-lowering effect of plant sterols and stanols has been proven in a vast number of clinical studies, which formed the basis of authorized health claims by international regulatory bodies in many countries around the world. The cholesterol-lowering benefit is further recognized in many guidelines for the management of dyslipidaemias of leading societies such as in the recently published 2016 Guidelines of these two leading European societies.

 

Successful 3rd International Plant Sterols/Stanols Health and Disease Conference in Winnipeg

The 3rd international Plant Sterols/Stanols, Health and Disease Congress was held in Winnipeg, Canada, on September 29th – October 1st, 2016. The congress gathered together scientists, clinicians, and industry representatives from Europe and North America. The congress programme included several sessions addressing a range of topics including presentations on the LDL-cholesterol lowering effect and other potential beneficial health effects of plant sterols and plant stanols , plant sterol/stanol analytics, and the role of foods with added plant sterols and stanols in the management of hypercholesterolemia. Another key topic of the congress was the rare inherited condition called sitosterolemia, which was discussed both from clinical and patient perspectives. All congress presentations were of high quality and the discussion and interaction amongst conference participants were very active. IPSSA was one of the supporters of this congress. The proceedings of the congress will be published in due course.

For more details on the program and the speakers, please visit the conference homepage http://plantsterolconference.com/

New meta-analysis estimating the effects of plant sterols/stanols on plasma fat-soluble vitamins and carotenoids demonstrates that the intake of sterols/stanols is not leading to undesirable effects

The LDL-cholesterol lowering benefit of plant sterols/stanols is well established and including foods with added plant sterols/stanols into a cholesterol lowering diet is a common practice for many people. Plant sterols/stanols lower LDL-cholesterol by inhibiting cholesterol uptake (absorption) from the gut. Questions are sometimes raised whether plasma concentrations of fat-soluble vitamins and carotenoids are also affected by plant sterol/stanol consumption since their uptake follows that of cholesterol.

A new paper, ‘Plasma fat-soluble vitamin and carotenoid concentrations after plant sterol and plant stanol consumption – a meta-analysis of randomized controlled trials’
Baumgartner et al. Eur J Nutr (2016). doi:10.1007/s00394-016-1289-7 (available in open access), investigated the effect of plant sterol/stanol intake on plasma fat-soluble vitamins (i.e. vitamins A, E and D) and carotenoids concentrations (α- and β-carotene and others) to provide an up-to-date quantitated overview based on a meta-analysis of 41 randomized controlled studies including 3,306 individuals.

Plasma concentrations of vitamins A and D were not affected; neither were cholesterol-standardized concentrations of vitamin E.

Cholesterol-standardized concentrations of α- and β-carotene and lycopene decreased by 6 to 10%. Overall, the observed changes were modest and within normal ranges.

Therefore, the intake of foods with added plant sterols/stanols is not leading to undesirable effects as new evidence shows that plasma carotenoid levels remain within normal ranges after consumption of these foods.

Furthermore, the modest changes in blood carotenoid concentrations being within typical inter-individual variation are considered physiologically insignificant. A sufficient intake of fruit and vegetables as part of a healthy diet accompanying the consumption of foods with added plant sterols/stanols also prevents modest reductions in plasma carotenoid concentrations.

New review article emphasizes the role and lifestyle intervention in reducing blood LDL-cholesterol

A recent paper authored by Riccardi et al and published in the Current Cardiology Reports (July 2016 18:66) reviews the role of lifestyle modifications to control high blood LDL-cholesterol.

The article summarises the evidence of implementing lifestyle modifications such as physical activity and diet – including the role of functional foods with added plant sterols and stanols – in reducing blood LDL-cholesterol, a major risk factor for the development of cardiovascular disease (CVD) which is a significant public health threat.

The article highlights association between the consumption of foods with added plant sterols/stanols with a significant reduction in LDL-cholesterol. Therefore, plant sterols and stanols have a significant role to play in managing LDL-cholesterol levels in people whose absolute risk for developing CVD does not qualify for pharmacotherapy.

Conversely, for people with high risk for developing CVD and in need of pharmacotherapy, the research cited in the article finds that introducing plant sterols and stanols in the daily diet provides an additional beneficial effect in reducing their LDL-cholesterol levels.

Additionally, the article demonstrates that a switch to a heathy diet low in saturated fat and the addition of dietary fibre and foods with added plant sterols and stanols can lead to a reduction in LDL-cholesterol levels of 30-35% which is a substantial effect.

The abstract of the article is available for free here and here

84th Congress of the European Atherosclerosis Society concludes with success

The 84th Congress of the European Atherosclerosis Society took place from 29 to 1 June and was concluded with success.

During the Congress, the review of the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice confirmed the significance of diet and lifestyle as the first fundamental step for the prevention of Cardiovascular Disease (CVD).

With the emphasis on the quality of diet, it was also stressed that the importance of lowering LDL-cholesterol should not be neglected. Furthermore, there is also consistent evidence for a role for foods with added plant sterols and stanols, which at a daily intake of 2 g/day lower LDL-C by up 10%.

For more information, please read the EAS announcement.

IPSSA Call for Action on World Health Day: Measure Your Cholesterol!

Brussels, 7 April: Today is World Health Day, a milestone that has been established by the World Health Organization (WHO) and this year the focus is on diabetes. According to WHO about 350 million people worldwide have diabetes, and 90% of diabetes cases are type 2[1].

The International Plant Sterols and Stanols Association (IPSSA), the leading association in the sector of plant sterols and stanols comprised of the major international companies (Arboris, BASF, Cargill, Danone, Raisio, Unilever), fully supports the goals of WHO this World Health Day to combat diabetes.

We would therefore like to use the opportunity of this milestone date to make a call for action and to ask diabetics and people in the general population to measure their cholesterol and take action to reduce or maintain at normal their LDL-cholesterol levels.

Elevated LDL-cholesterol has no physical symptoms that could alert someone and yet it is a significant heart disease risk factor. Diabetics in particular, but also the general population, need to take action as early as possible and measure their cholesterol through a simple blood test. The good news is that through a healthy and active lifestyle and a diet – essential for diabetics – LDL-cholesterol levels can be lowered significantly, Geert van Poppel, IPSSA Chairman comments. But people must take action, measure, and become aware of their cholesterol levels sooner rather than later, he concludes.

We believe that awareness of their cholesterol level is an important step for diabetics as:

  1. People with diabetes are at increased risk for cardiovascular diseases, such as coronary heart disease[2]
  2. Adults with diabetes are about two to four times more likely to have heart disease than adults without diabetes[3]
  3. A key problem in people with diabetes is in fact dyslipidaemia, characterised by too much LDL (“bad”) cholesterol, not enough HDL (“good”) cholesterol, and high triglycerides next to high blood pressure, risk factors for heart disease
  4. Therefore, it is very important that cardiovascular risk factors, such as LDL-cholesterol, are optimally managed
  5. LDL-cholesterol goals for people with diabetes are stricter than for people without diabetes, which is why it is extremely important that all effective measures to reduce LDL-cholesterol are taken[4]:
    • The goal for LDL-cholesterol in people with diabetes is according to current guidelines <2.5 mmol/l (less than ˜ 100 mg/dl) or <1.8 mmol/l (less than ˜ 70 mg/dl)
    • The general LDL-C goal for healthy individuals is <3.0 mmol/l (less than ˜ 115 mg/dl)
  6. It has been scientifically proven that a daily consumption of foods and food supplements with 1.5 – 3.0g of added plant sterols or stanols can lower blood LDL-cholesterol dose-dependently by 7-12.5% in 2-3 weeks as part of the daily diet[5]

Diabetes, a global and EU epidemic, is a preventable (type 2) and manageable condition (all types) if people take early action. The WHO is this year working with governments and civil society partners to increase awareness about the rise of diabetes and trigger a set of specific, effective, and affordable actions to tackle the disease which carries a huge economic toll on all countries but in particular middle and low-income ones. The main message of WHO that IPSSA fully subscribes to is that a large number of diabetes cases are preventable while diabetes itself is treatable. See more at http://www.who.int/campaigns/world-health-day/2016/en/

 

***ENDS***

 

About the International Plant Sterols and Stanols Association (IPSSA):

We are an association of global companies in the sector of plant sterols and stanols and our members are: Arboris, BASF, Cargill, Danone, Raisio, and Unilever. Plant sterols and stanols are abundant in nature and provide cholesterol-lowering properties. It has been scientifically proven and recognized by regulatory authorities around the world that a daily consumption of foods and food supplements with 1.5 – 3.0g of added plant sterols or stanols can lower blood LDL-cholesterol dose-dependently by 7-12.5% in 2-3 weeks as part of the daily diet. Our mission is to educate media, policy makers and the public about the efficacy and safety of eating plant sterols and stanols as part of a balanced diet to lower raised cholesterol.

For more information, please contact:

Konstantinos Maragkakis

Communications Manager and Spokesperson

km@ipssa-association.com

+32 472 280 742 (Mobile)

 

[1] http://www.who.int/campaigns/world-health-day/2016/en/

[2] http://www.who.int/mediacentre/factsheets/fs312/en/

[3] http://care.diabetesjournals.org/content/38/9/1777.full.pdf+html

[4] http://eurheartj.oxfordjournals.org/content/ehj/early/2012/05/02/eurheartj.ehs092.full.pdf

[5] http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv%3AOJ.L_.2014.182.01.0027.01.ENG

IPSSA – Bringing to the agenda plant sterols and stanols and their contribution in reducing blood LDL-cholesterol levels

BRUSSELS, 11 November 2015 – It is with great pride that we announce the launch of the International Plant Sterols and Stanols Association (IPSSA – www.ipssa-association.com) , comprised of the leading international companies in plant sterols and stanols. The IPSSA members have decided to work together to educate the public about the benefits of integrating plant sterols and stanols in the daily diet. We also aim to foster the idea of healthy diet and lifestyle choices as effective means of reducing blood LDL-cholesterol – a major risk factor for heart disease.

We at IPSSA are convinced that we can actively contribute to the public health agenda by raising awareness with policymakers and consumers.

We believe that a healthy diet and an active lifestyle can prevent high blood LDL-cholesterol which is one of the main factors in development of heart disease. It has been scientifically proven by numerous academic studies that a daily consumption of foods and food supplements with 1.5 – 3.0g of added plant sterols or stanols can lower blood LDL-cholesterol by 7-12.5% in 2-3 weeks as part of the daily diet.

Consuming, therefore, foods with added plant sterols or stanols is an effective way to contribute to the lowering of blood LDL-cholesterol. One effective way to do so is, for example, by switching the usual spreads (such as butter or margarine) or yoghurt for the spreads or yoghurt with added plant sterols and stanols.

“Reducing the risk of cardiovascular disease is an important priority in the EU public health agenda. We support that a healthy lifestyle and nutrition aiming at effective LDL-cholesterol lowering are key factors in the reduction of overall risk for heart disease, Geert van Poppel, Chairman of IPSSA comments. “IPSSA intends to contribute to the public debate by introducing facts about plant sterols and stanols. These come from scientific research and will help us inform and educate the public about the need to keep their LDL-cholesterol levels low and maintain an active and healthy lifestyle. We also aim to convey to policymakers the message that reducing risk factors for cardiovascular disease is an important component of efficient long-term public health policy and sustainable development”, Geert Van Poppel concludes.

 


 

What are plant sterols and stanols?

Plant sterols and stanols are substances that are abundant in nature, generally found in plant based foods such as vegetable oils, grains, vegetables, fruits, legumes, nuts, and seeds. Their cholesterol-lowering properties have been known since the 1950s. Cholesterol is a waxy substance found naturally in the blood and it is essential for normal body function. It is mainly produced in the body and is transported around the blood in ‘vehicles’ called lipoproteins.

The two main types of lipoproteins are LDL and HDL with LDL-cholesterol having been proven as the type of cholesterol that in too high levels can slowly build up in the arteries, making them narrower. Therefore, too high levels of LDL-cholesterol increase significantly the risk of heart disease.

Cardiovascular disease – Some key facts:

Some facts about cardiovascular (heart) diseases according to the World Health Organization (WHO):

  • Cardiovascular diseases are the number 1 cause of death globally: more people die annually from cardiovascular diseases than from any other cause[1]
  • An estimated 17.5 million people died from cardiovascular diseases in 2012, representing 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to coronary heart disease and 6.7 million were due to stroke[2]
  • 80% of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention. Checking and controlling risk factors for heart disease and stroke such as high blood pressure, high cholesterol and high blood sugar or diabetes is also very important[3]
  • Raised cholesterol increases the risks of heart disease and stroke. Globally, a third of ischemic heart disease is attributable to high cholesterol. Overall, raised cholesterol is estimated to cause 2.6 million deaths (4.5% of total) and 29.7 million disability adjusted life years (DALYs), or 2.0% of total DALYs[4]

Currently, IPSSA is comprised of the following companies: Arboris, BASF, Cargill, Danone, Raisio, and Unilever.

For more information, please contact:

Konstantinos Maragkakis

Communication Manager and Spokesperson

km@ipssa-association.com

+32 472 280 742 (Mobile)

 

[1] http://www.who.int/mediacentre/factsheets/fs317/en/

[2] Ibid

[3] http://www.who.int/features/qa/27/en/

[4] http://www.who.int/gho/ncd/risk_factors/cholesterol_text/en/