Purpose: To assess the long-term effects and costs of the use of recently introduced margarines (e.g. Benecol) enriched with stanol esters in comparison to statins and on top of statins. Methods: A dynamic Markov chain model is used that links the Framingham risk equation to the incidence of cardiovascular events and to their consequences in terms of survival, costs and quality adjusted life years. Costs-effectiveness is expressed in terms of costs per life year gained. Spreading six sandwiches a day with Benecol is associated with a 10%-decrease in LDL. Statin use is associated with a 35%-decrease in events (after a 1-year-delay). Comparative cost-effectiveness is calculated for different risk groups for 5 and 1 year of “therapy”. Results: Costs per life year gained of taking a generic statin vary from €15.000 for a 50-year old male at low risk (10-year risk of a stroke, MI or cardiovascular death of 15%) to €1.600 for the same patient at high risk (10-year risk of a cardiovascular event of 50%). These figures are €21.000. and €3.000 for the use of stanol esters enriched margarine. After having started statin treatment, the additional costs per life year gained of spreading enriched margarine are estimated at respectively €30.000 (low risk) and €5.000 per life year gained (high risk). Numbers needed to “treat” for one year to prevent one cardiovascular event are estimated at 11.200 and 190 respectively. Number (of sandwiches) needed to spread to prevent one cardiovascular event are estimated at 260.000 and 42.000 respectively. Conclusion: For the prevention of cardiovascular events, statin treatment is more cost-effective than using stanol esters enriched margarine. For high risk patients, these margarines may offer a welcome addition to statins with a favorable cost-effectiveness ratio. Furthermore, compliance to margarine may be better than to statins.