The health-epidemiological retrospective observational study included 1631 people (58.5 per cent male) with at least two risk factors for CVD. Twenty-four per cent of the participants were on anti-diabetic medication and about 90 per cent were receiving anti-hypertensive therapy.
Despite the widely advertised benefits of using phytosterol-enriched margarines (PEM), the researchers report that only 15 per cent of the population (244 people) were consuming the margarines, and of these only 89 people consumed the recommended daily amount.
"This under use of PEM in this high risk population is worrisome, all the more so as our study population was a selection of patients with regular medical follow up for their dyslipidemia," wrote lead author Laurent Laforest from the University of Lyon.
Numerous clinical trials in controlled settings have reported that daily consumption of 1.5 to 3 grams of phytosterols/-stanols can reduce total cholesterol levels by eight to 17 per cent, representing a significant reduction in the risk of cardiovascular disease.
High cholesterol levels, hypercholesterolaemia, have a long association with many diseases, particularly cardiovascular disease (CVD), the cause of almost 50 per cent of deaths in Europe, and reported to cost the EU economy an estimated €169bn ($202bn) per year.
The new study, published in the journal Nutrition, Metabolism and Cardiovascular Diseases, raises the questions as to why the phytosterol message may not be getting through to those who would benefit the most.
"Some patients may not perceive the utility of preventive measures such as diet, exercising or PEM use, as long as they receive a lipid lowering treatment. Another limitation to PEM use could be the high price, which could dissuade some patients with low incomes," they said.
No information about socio-economic factors was recorded in this study.
The researchers also stated that no information was available as to whether the patients received sufficient information from the general practitioners about the benefits of PEM.
"This study highlighted, not only the low use of PEM in this population of high cardiovascular risk patients but also underlines the inadequate level of use among consumers," said the researchers.
"Educational campaigns are needed to improve the use of phytosterol-enriched nutriments and more generally cardiovascular disease prevention in this high risk population."
The results are somewhat at odds with a study based in The Netherlands that showed that the message was getting through to the target group of people with high cholesterol levels in Holland (Food and Chemical Toxicology, Vol. 44, pp. 1682-1688).
Ingmar Wester, vice president regulatory and scientific affairs at Raisio and inventor of Benecol ingredient, told NutraIngredients.com in August that the Dutch study clearly confirmed the beneficial effects on serum cholesterol of phytosterol/-stanol-enriched margarine-type spreads, even though the recorded intake was surprisingly lower than the recommended.
"The fact that more subjects amongst users were diagnosed with high cholesterol and that the mean serum cholesterol levels of users was significantly higher than that of the non-users shows that the products efficiently have found the target group, indicating that the marketing messages have been appropriate," he said.
Source: Nutrition, Metabolism and Cardiovascular Diseases Published on-line ahead of print. doi:10.1016/j.numecd.2006.07.012 "Use of margarine enriched in phytosterols by patients at high cardiovascular risk and treated by hypolipidemic drugs" Authors: L. Laforest, P. Moulin, M-S. Schwalm, P. Le Jeunne, S. Chretin, B. Kitio, J. Massol and E. Van Ganse