BRIEF COMMUNICATIONS Regular Use of Margarine-Containing Stanol/Sterol Esters Reduces Total and Low-Density Lipoprotein (LDL) Cholesterol and Allows Reduction of Statin Therapy After Cardiac Transplantation: Preliminary Observations Anne Vorlat, MD, Viviane M. Conraads, MD, PhD, and Christiaan J. Vrints, MD, PhD Seventeen stable cardiac transplant recipients, of whom 16 were on statin therapy, used margarine with stanol/sterol esters. Total cholesterol in the treatment group was lowered from 211 mg/dl (range 168 to 244) to 177 mg/dl (136 to 241) (17% reduction, p = 0.003) and low-density lipoprotein (LDL) cholesterol was reduced from 125 mg/dl (73 to 161) to 98 mg/dl (57 to 146) (22% reduction, p = 0.0006). LDL cholesterol reached the pre-defined cut-off level of 115 mg/dl in 12 of 17 patients and statin dosages were reduced. In 8 of 12 patients, LDL cholesterol remained at 115 mg/dl 6 weeks after statin reduction. J Heart Lung Transplant 2003;22:1059 –1062. Dyslipidemia is common after cardiac transplan- tation. Multiple factors promote dyslipidemia in transplant recipients: immunosuppression with cy- closporine and steroids; anti-hypertensive agents, and concomitant conditions, such as diabetes, obe- sity, age and male gender. Total and low-density lipoprotein (LDL) cholesterol are prominent risk factors for major progression of cardiac allograft vascular disease. 1 Although small trials have shown efficacy of statins, both in terms of graft vessel disease and mortality, there are presently no guide- lines for this population. 2 To achieve low LDL cholesterol levels high dosages of statins are usually required in transplant recipients. High concentra- tions of these drugs, particularly in combination with cyclosporine, may increase the risk of side effects and introduce the possibility of myositis and rhab- domyolysis. 4 Plant stanol and sterol esters reduce serum cholesterol by inhibition of cholesterol ab- sorption. 5 Substitution of part of the daily fat intake with stanol ester margarine has been shown to reduce serum cholesterol by 10.2% and LDL cho- lesterol by 14% after 1 year. 5 The concomitant use of statins and stanol esters has shown additional lipid-lowering effects. 6 To our knowledge, no com- From the Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium. Submitted July 30, 2002; revised November 2, 2002; accepted November 26, 2002. Reprint requests: Anne Vorlat, MD, Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. Telephone: +32-3821-3538. Fax: +32-3830-2305. E- mail: anne.vorlat@uza.be Copyright © 2003 by the International Society for Heart and Lung Transplantation. 1053-2498/03/$–see front matter doi:10.1016/S1053-2498(02)01222-6 1059