Abstract
Some studies have suggested that a modest increase of plant sterol levels is a risk factor for coronary artery disease (CAD). We studied the relationship between plant sterol levels and CAD risk in a prospective nested case-control study consisting of 373 cases and 758 controls. Sitosterol and campesterol concentrations did not differ between cases and controls [sitosterol, 0.21 vs. 0.21 mg/dl (P = 0.1); campesterol, 0.31 vs. 0.32 mg/dl (P = 0.5)]. The sitosterol-to-cholesterol ratio was significantly lower in cases than in controls (1.19 vs. 1.29 microg/mg; P = 0.008), whereas the campesterol-to-cholesterol ratio did not differ significantly (1.78 vs. 1.88 microg/mg; P = 0.1). Plant sterol concentrations correlated positively with cholesterol levels and inversely with body mass index and triglyceride and lathosterol concentrations. Among individuals in the highest tertile of the sitosterol concentration, the unadjusted odds ratio (OR) for future CAD was 0.75 [95% confidence interval (CI) = 0.56-1.01]. After adjustment for traditional risk factors, the OR was 0.79 (95% CI = 0.56-1.13). For the campesterol concentration, the unadjusted OR was 0.95 (95% CI = 0.71-1.29) and the adjusted OR was 0.97 (95% CI = 0.68-1.39). In this large prospective study, higher levels of plant sterols, at least in the physiological range, do not appear to be adversely related to CAD in apparently healthy individuals.
Highlights
Some studies have suggested that a modest increase of plant sterol levels is a risk factor for coronary artery disease (CAD)
The sitosterol-to-cholesterol ratio was inversely associated with CAD, but significance was lost after adjustment for traditional risk factors
Only univariate analysis was performed, and it is unclear whether the positive association between plasma sitosterol levels and coronary events would have remained significant if multivariate analyses had been performed to adjust for potential confounders
Summary
Some studies have suggested that a modest increase of plant sterol levels is a risk factor for coronary artery disease (CAD). The unadjusted OR was 0.95 (95% CI 5 0.71–1.29) and the adjusted OR was 0.97 (95% CI 5 0.68–1.39) In this large prospective study, higher levels of plant sterols, at least in the physiological range, do not appear to be adversely related to CAD in apparently healthy individuals.—Pinedo, S., M. The lower net absorption of plant sterols compared with cholesterol is attributable to the active resecretion of plant sterols back into the enteric lumen. In individuals with dysfunctional ABCG5 and/or ABCG8, plant sterol net absorption is increased, resulting in 50-fold increased plasma levels of plant sterols In patients with this rare inherited autosomal recessive disorder sitosterolemia, sitosterol levels range between 10 and 30 mg/dl [10], whereas in normal subjects, these levels seldom exceed 1 mg/dl [3]. This article is available online at http://www.jlr.org
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