Moderately elevated plant sterol levels are associated with reduced cardiovascular risk—The LASA study

Faßbender, Klaus; Lütjohann, Dieter; Dik, Miranda G.; Bremmer, Marijke A.; König, J.; Walter, Silke; Liu, Yang; Letièmbre, Maryse; Bergmann, Klaus von; Jonker, Cees

doi:10.1016/j.atherosclerosis.2006.10.032

Cited by 118 publications

(78 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is clear that the topic of plasma phytosterols and cardiovascular risk is controversial. Our results agree with those of some recent studies (13)(14)(15) in suggesting a lack of association and even a protective role of elevated plasma phytosterol concentrations on risk of future CHD.…”

Section: Characteristics Of Chd Cases and Matched Controlssupporting

confidence: 80%

“…Miettinen et al ( 27 ) reported an association between raised plasma phytosterol levels and increased phytosterol content of surgically removed carotid plaques, while Weingärtner et al ( 28 ) showed that consumption of phytosterol-enriched margarine correlated with increased plasma concentrations and tissue deposi- An additional factor that infl uences plasma phytosterolto-cholesterol ratios is statin treatment ( 7,36 ), a reason why statin users were excluded from the analyses. Finally, the plasma sitosterol and campesterol ratios to cholesterol were in the same physiological range as reported in previous studies (9)(10)(11)(12)(13)(14)(15)30 ), strengthening the reliability of our data.…”

Section: Characteristics Of Chd Cases and Matched Controlssupporting

confidence: 72%

“…The controversy on whether raised plasma phytosterols are a CHD risk factor in nonsitosterolemic individuals has been fed by the inconsistent fi ndings of epidemiological studies (9)(10)(11)(12)(13)(14)(15). Other contradictory evidence has been presented recently.…”

Section: Characteristics Of Chd Cases and Matched Controlsmentioning

confidence: 94%

“…Second, only a single measure of dietary exposure and risk factor status at baseline was available; therefore, changes in diet and other lifestyle variables that might have infl uenced CHD risk throughout the ‫ف‬ 10 year follow-up were not accounted for. Finally, it could be argued that the fi ndings are specifi c for the Mediterranean cohort studied, but the similarity of plasma noncholesterol levels with those reported in epidemiologic studies from the US ( 9,26,30 ), Finland ( 10 ), Germany ( 11,12,14 ), the UK ( 13 ), and The Netherlands ( 15 ) suggests that they may be generalized to other populations.…”

Section: Characteristics Of Chd Cases and Matched Controlsmentioning

confidence: 99%

“…This is a substantial concern, given that inhibition of cholesterol absorption by gram doses of phytosterols incorporated into various foods is widely used as a nonpharmacological strategy for cholesterol lowering but is associated with increased serum phytosterol concentrations ( 8 ). Results of epidemiological studies have suggested either a direct association between plasma phytosterols and coronary heart disease (CHD) risk (9)(10)(11)(12) or a null ( 13,14 ) and even inverse association ( 15 ).…”

Section: Laboratory Measurementsmentioning

confidence: 99%

See 4 more Smart Citations

Phytosterol plasma concentrations and coronary heart disease in the prospective Spanish EPIC cohort

Escurriol

Cofán

Moreno-Iribas

et al. 2010

Journal of Lipid Research

View full text Add to dashboard Cite

This article is available online at http://www.jlr.org heart disease in the prospective Spanish EPIC cohort. J. Lipid Res . 2010. 51: 618-624. Supplementary key words plant sterols • sitosterol • campesterol • lathosterol • cholesterol • European Prospective Investigation intoCancer and Nutrition • nested case-control study • cardiometabolic risk • apolipoprotein E Dietary sterols consist of animal-derived cholesterol and plant-derived noncholesterol sterols or phytosterols. Phytosterols are important components of a vegetable-based diet and are particularly abundant in whole grains, nuts, seeds, and oils derived from them. The principal molecular forms are sitosterol and campesterol ( 1 ). These compounds are structurally related to cholesterol but have bulkier and more hydrophobic molecules, which confer them a higher affi nity for intestinal micelles than has cholesterol. Consequently, cholesterol is displaced from micelles, and the amount available for absorption is limited. The phytosterol content of usual diets is similar to that of cholesterol (150 to 450 mg/day), but their intestinal absorption is much less effi cient (see review in Ref.2 ). Because of low absorption and rapid biliary elimination, physiological plasma concentrations of phytosterols are in the order of 10 Ϫ 3 those of cholesterol. Their ratios to cholesterol are accepted as surrogate markers for the effi ciency of cholesterol absorption, while those of the Abstract Phytosterol intake with natural foods, a measure of healthy dietary choices, increases plasma levels, but increased plasma phytosterols are believed to be a coronary heart disease (CHD) risk factor. To address this paradox, we evaluated baseline risk factors, phytosterol intake, and plasma noncholesterol sterol levels in participants of a case control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) Spanish cohort who developed CHD (n = 299) and matched controls (n = 584) who remained free of CHD after a 10 year follow-up. Sitosterol-to-cholesterol ratios increased across tertiles of phytosterol intake ( P = 0.026). HDL-cholesterol level increased, and adiposity measures, cholesterol/HDL ratios, and levels of glucose, triglycerides, and lathosterol, a cholesterol synthesis marker, decreased across plasma sitosterol tertiles ( P < 0.02; all). Compared with controls, cases had nonsignifi cantly lower median levels of phytosterol intake and plasma sitosterol. The multivariable-adjusted odds ratio for CHD across the lowest to highest plasma sitosterol tertile was 0.59 (95% confi dence interval, 0.36-0.97). Associations were weaker for plasma campesterol. The apolipoprotein E genotype was unrelated to CHD risk or plasma phytosterols. The data suggest that plasma sitosterol levels are associated with a lower CHD risk while being markers of a lower cardiometabolic risk in the EPIC-Spain cohort, a population with a high phytosterol intake. -Escurriol,

show abstract

Section: Characteristics Of Chd Cases and Matched Controlssupporting

confidence: 80%

Section: Characteristics Of Chd Cases and Matched Controlssupporting

confidence: 72%

Section: Characteristics Of Chd Cases and Matched Controlsmentioning

confidence: 94%

Section: Characteristics Of Chd Cases and Matched Controlsmentioning

confidence: 99%

Section: Laboratory Measurementsmentioning

confidence: 99%

See 3 more Smart Citations

Phytosterol plasma concentrations and coronary heart disease in the prospective Spanish EPIC cohort

Escurriol

Cofán

Moreno-Iribas

et al. 2010

Journal of Lipid Research

View full text Add to dashboard Cite

show abstract

Cholesterol-Lowering Foods and Reduction in Serum Cholesterol Levels—Reply

Ramprasath¹

2011

JAMA

View full text Add to dashboard Cite

In Reply: Dr Dowdy points out that a substantial proportion of the person-time in our study occurred among former smokers. As individual former smokers cannot change their status to never-smokers, he questions whether our presentation of PARs is meaningful. Although individual former smokers cannot become never-smokers, it is conceivable to eliminate cigarette smoking at the population level. The first use of the PAR was by Levin in 1953 for the purpose of estimating the burden of lung cancer caused by ever smoking, 1 and this approach has been used many times subsequently, including the US Surgeon General's Report on the Health Consequences of Smoking. 2 We suggested 3 possible explanations for higher HRs in our study than in previous studies, including changing cigarette composition, increasing detection bias for bladder cancer in smokers, and chance. Dowdy suggests a fourth possible explanation, whereby unmeasured or poorly measured confounders, perhaps associated with socioeconomic status, may be more prominent in current smokers in the present day than in the 1980s. In our study cohort, as in the reference cited by Dowdy, 3 current smoking was associated with lower educational attainment (18% of participants with less than a college education were current smokers compared with 11% of participants with a college education), whereas the proportion of former smokers was 52% in both groups. The proportion of current smokers also varied by race/ethnicity, with 15% non-Hispanic white individuals, 20% non-Hispanic black individuals, 11% Hispanic individuals, and 10% Asian/Pacific Islander/Native American individuals being current smokers. For former smoking, the corresponding proportions were 52%, 43%, 47%, and 41%, respectively.In our models, we adjusted for education and race/ ethnicity and in this way indirectly for environmental exposures associated with these factors. Although models were adjusted for education and race/ethnicity (current vs never smoking, HR, 4.06; 95% CI, 3.66-4.50), risk estimates were quite similar in models adjusted for only age and sex (HR, 4.17; 95% CI, 3.77-4.62). Nevertheless, as in all observational studies, unmeasured or poorly measured confounders may have affected our risk estimates. Future studies are needed to replicate our findings in other populations and to directly evaluate the role of cigarette composition in bladder cancer etiology.

show abstract