Abstract P187: Intake of Plant Sterols from Natural Sources and Risk of Cardiovascular Disease in the EPIC-NL Population

Abstract

Background: Plant sterols (PS) are known to lower low-density lipoprotein (LDL-)cholesterol, which is an established risk factor for cardiovascular disease (CVD). Whether a high intake of PS indeed reduces the risk of CVD is unknown. This study aimed to investigate the relations of dietary intake of naturally occurring PS with blood lipids and CVD risk. Methods: The study included 35,597 Dutch men and women, aged 20-70 years, participating in the European Prospective Investigation into Cancer (EPIC-NL) study. Intakes of PS were estimated with a validated food frequency questionnaire (correlation of 0.59 for energy adjusted PS intake against 12 24-hour recalls). Occurrence of CVD was determined through linkage with registries. Blood lipids were measured at baseline. Associations with cardiovascular endpoints were analyzed prospectively using Cox proportional hazard models; this was done for total CVD, total coronary heart disease (CHD) and myocardial infarction (MI). Associations with blood lipids were analyzed cross-sectionally using regression models in a random sample of the baseline cohort (n=2417). Results: Average energy-adjusted PS intake was 295.8 ±49 mg/d (mean ±SD) and ranged from 231.3 ±22.0 to 366.0 ±34.9 mg/d between the lowest and highest quintiles. During follow-up, 3047 CVD cases were documented, including 1807 cases of CHD and 606 cases of MI. Adjusted for CVD risk factors, lifestyle and dietary factors, naturally occurring PS intake was not associated with risk of CVD, CHD or MI (P-value trend >0.05). However, PS intake was associated with a lower risk of CHD in the second (HR: 0.83; 95%CI: 0.72; 0.97) and third (0.84; 0.72; 0.98) quintiles vs. the lowest quintile of PS intake, but not in the fourth (0.90; 0.76-1.06) and fifth quintile (0.84; 0.70-1.01). Higher PS intake was associated with lower total cholesterol (-0.06 mmol/L; P-value 0.038) and lower LDL-cholesterol (-0.07 mmol/L; P-value 0.007) per 50 mg/d incremental PS intake. These associations were stronger in men than in women. Conclusions: In this population with a relatively narrow and low range of naturally occurring PS intake, PS intake was not associated with a reduced cardiovascular risk, although total- and LDL-cholesterol concentrations were lower in people with higher intakes of PS. Future studies should preferably investigate the association between PS intake and CVD risk in populations with higher PS intakes .