The document, published last month by the NHS's National Institute for Health and Clinical Evidence (NICE), is designed to guide UK health professionals in giving cardiovascular health advice and issued about every four years. But industry says there is no great surprise in the recommendations as they relate to primary prevention for those at high risk of cardiovascular disease and don't expect they will drastically deflate either sector. Primary prevention in this area is the almost exclusive domain of statin drugs although the guidance does note that functional foods and supplements can play a complementary role. Sterols and stanols The fact plant sterols and stanols had been singled out was disappointing nonetheless, said Ingmar Wastar, the research and development director at Raisio Ingredients, which manufactures, markets and distributes Benecol cholesterol-lowering stanols. "We are disappointed to see that dietary tools available to lower cholesterol have not been acknowledged to their full potential," he said. Colette Shortt, the regulatory director at McNeill Nutritionals, which markets cholesterol-lowering Benecol products in the UK and other countries, said while it was not ideal that stanol and sterol foods had been named, the guidelines had also noted the potential of such products in lowering cholesterol. NICE called for more research linking cholesterol reduction and CVD. "While we are concerned about how this kind of report can be picked up by the mainstream media and made to alarm consumers, NICE's findings recognise a role for sterols and stanols but not as a substitute for statin drugs," Shortt said. "Which is our position anyway." However she questioned why other ingredients with cholesterol-lowering potential such as soy isoflavones and oats had escaped mention. A spokesperson for Unilever, which owns the Flora pro.activ brand that is Benecol's main competitor in the cholesterol-lowering food area, agreed it was positive the cholesterol-lowering effect of sterol foods was acknowledged by NICE. "[But] we are disappointed that doctors are being told not to recommend plant sterol-containing foods," said Trevor Gorin, Unilever's global media relations director. "There are 140 studies to show that plant sterols significantly lower cholesterol and there is strong evidence to show that lowering cholesterol reduces the risk of cardiovascular disease." In response to the NICE guidance, the British Heart Foundation (BHF) said today: "Whilst there is evidence that plant sterols and stanols can help some people to lower their blood cholesterol levels, they are not a substitute for taking prescribed cholesterol-lowering medication or a balanced diet. The NICE guidelines highlight the need for more research on these products to examine long term effects and their effect on cardiovascular events, and we would welcome this." Omega-3 Dave Cherry, VP sales and marketing at UK-based fish oil supplier, Croda Europe Health Care, said there was nothing to be alarmed about in the guidelines and noted they supported the use of omega-3 fatty acids in secondary prevention. "The clinical evidence on the primary prevention of CVD whilst continuing to grow is not yet sufficient to allow clinical guidelines and recommendations to be made," he observed. He noted GOED (Global Organisation for EPA and DHA) and others were working to establish recommended daily intake levels for primary prevention of CVD. "Studies are not yet completed on the appropriate level of omega-3 fatty acid supplementation for primary prevention, so we would not expect NICE to make positive recommendation through GPs," he said. However the NICE recommendation does appear to contradict the UK's Joint Health Claim Initiative (JHCI) officially approved omega-3 health claim that states: "Eating 3g weekly, or 0.45g daily, long chain omega-3 polyunsaturated fatty acids, as part of a healthy lifestyle, helps maintain heart health. A NICE spokesperson said all evidence had been assessed and found wanting in the area of CVD, but that the policy was open to review if new evidence presented itself. The guideline stated: "People should not routinely be recommended to take omega-3 fatty acid supplements/ plant sterols and stanols for the primary prevention of CVD." The guidance can be found here.