Non-cholesterol sterols in serum, lipoproteins, and red cells in statin-treated FH subjects off and on plant stanol and sterol ester spreads

Abstract

Background Serum plant sterol levels are increased by consumption of statins and dietary plant sterols, and decreased by dietary plant stanols, but little is known about combination therapy of statin and plant sterols. Methods We measured plant sterols in serum, lipoproteins, and red cells in subjects with familial hypercholesterolemia (FH) ( n=18) treated with variable doses of statins off and on plant stanol (STA) and sterol ester (STE) spreads. Results STA and STE spreads lowered LDL cholesterol ∼15%. Plant sterols were decreased in serum, lipoproteins, and red cells by ∼25% with STA and increased from 37% to 80% with STE, especially with high statin doses. The changes in serum were related to those in red cells. The baseline levels of serum plant sterols were negatively ( r-range −0.639 to −0.935) and positively ( r-range 0.526 to 0.598) correlated with the respective changes evoked by the STA and STE spreads. Conclusions STE reduces LDL cholesterol, but increases serum, lipoprotein, and red cell plant sterol levels in statin-treated FH subjects, while all the respective values are decreased with STA. Recent predictions that elevated serum plant sterols pose an increased coronary risk suggest that increases of serum plant sterol levels should be avoided, especially in atherosclerosis-prone individuals, such as subjects with FH.