Abstract
Dietary plant sterols, such as campesterol and sitosterol, reduce plasma cholesterol concentrations, but any relationship to plaque development and CVD remains unclear. Some epidemiologic studies have suggested that elevated plasma plant sterol concentrations are atherogenic, including the Framingham Offspring Study that identified a positive association between plant sterol concentrations and CVD status. We hypothesized that this suggested atherogenicity relates to the oxidation status of plant sterols (i.e., concentrations of plasma oxyphytosterols). Therefore, in the Framingham Offspring Study cohort, we measured plasma oxyphytosterol concentrations in 144 patients with documented CVD and/or more than 50% carotid stenosis and 383 matched controls. We analyzed plasma oxyphytosterol concentrations by GC/MS/MS and performed conditional logistic regression analysis to determine associations between plasma plant sterol or oxyphytosterol concentrations and CVD status. We found that higher total cholesterol (TC)-standardized campesterol concentrations [odds ratio (OR): 2.36; 95% CI: 1.60, 3.50] and higher sitosterol concentrations (OR: 1.47; 95% CI: 1.09, 1.97) were significantly associated with increased CVD risk, as in the earlier study. However, the sum of absolute oxyphytosterol concentrations (OR: 0.99; 95% CI: 0.81, 1.21) and the sum of TC-standardized oxyphytosterol concentrations (OR: 0.98; 95% CI: 0.80, 1.19) were not associated with an increased CVD risk. Results were comparable for individual absolute and TC-standardized oxycampesterol and oxysitosterol concentrations. Plasma nonoxidized TC-standardized sitosterol and campesterol concentrations showed weak or no correlations with oxyphytosterol concentrations, while all individual plasma concentrations of oxyphytosterol correlated with each other. In conclusion, circulating plasma oxyphytosterols are not associated with CVD risk in the Framingham Offspring Study.
Highlights
Dietary plant sterols, such as campesterol and sitosterol, reduce plasma cholesterol concentrations, but any relationship to plaque development and CVD remains unclear
We report the results of a multivariate-adjusted approach showing that absolute plasma oxyphytosterol as well as total cholesterol (TC)-standardized oxyphytosterol concentrations were not associated with CVD risk, defined as documented CVD and/or 50% carotid stenosis, in participants of the Framingham Offspring Study
This indicates that the presence of circulating oxyphytosterols is most likely not an underlying reason for the existing controversy around the potential atherogenicity of elevated plasma plant sterol concentrations [12]
Summary
Dietary plant sterols, such as campesterol and sitosterol, reduce plasma cholesterol concentrations, but any relationship to plaque development and CVD remains unclear. We found that higher total cholesterol (TC)standardized campesterol concentrations [odds ratio (OR): 2.36; 95% CI: 1.60, 3.50] and higher sitosterol concentrations (OR: 1.47; 95% CI: 1.09, 1.97) were significantly associated with increased CVD risk, as in the earlier study. Frequently develop premature CVD, while cholesterol concentrations are normal or only slightly increased [6] It should be noted, that increases in plant sterol concentrations after the consumption of plant sterolenriched products are only marginal compared with the severely elevated concentrations seen in phytosterolemic patients [4]. Some but not all epidemiological studies have reported positive associations between circulating plasma plant sterol concentrations and increased CVD risk [8,9,10]. In the Framingham Offspring Study, plasma total cholesterol (TC)-standardized sitosterol and campesterol concentrations were associated with 1.86- and 2.47fold increases in CVD risk, respectively [9]. There was, substantial heterogeneity among the studies due to the use of different statistical approaches and study designs and lack of standardized methodology to measure plant sterol concentrations
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