The associations of cholesterol metabolism and plasma plant sterols with all-cause and cardiovascular mortality

Modell zum individualisierten Lipidmanagement

“…So berichteten Silbernagel et al [20], dass eine hohe Cholesterinresorption und niedrige Cholesterinsynthese direkt mit dem Schweregrad einer koronaren Herzerkrankung assoziiert ist. In einer Nachfolgeuntersuchung der LURIC-Studie war eine erhöhte Sterolresorption direkt mit erhöhter kardiovaskulärer Mortalität assoziiert [21]. Wir berichteten zuvor, dass der Quotient Campesterol/Lathosterol im Serum (Cholesterinresorptionsmarker/Cholesterinsynthesemarker) direkt mit dem Schweregrad der koronaren Herzerkrankung assoziiert ist und ein starker Prädiktor für das Vorliegen einer koronaren Herzerkrankung ist [22].…”

Do clinical and experimental investigations support an antiatherogenic role for dietary phytosterols/stanols?

“…However, the authors emphasized that their data could not be extrapolated to a population at high cardiovascular risk. We interpret their conclusion because elevated plasma PS levels not only reflect increased cholesterol absorption but also a higher amount of plant-based foods in the diet (64); future clinical trials should carefully consider this issue. It should be emphasized that the role of PS supplementation is to impair the intestinal absorption of cholesterol, as demonstrated in a study based on the technique of steroid fecal balance (66).…”

“…A cohort study also demonstrated that a high PS plasma concentration may be associated with increased premature CHD, but did not provide PS corrections for the plasma total cholesterol concentration (63). In the LURIC trial performed in Germany, a low index of cholesterol synthesis (indicated by a lower concentration of lathosterol in plasma) that indirectly indicates high absorption of cholesterol correlated with an increase in mortality due to CVD (64). In other words, from a cardiovascular point of view, a greater capacity to absorb sterols would be harmful even though the cholesterol synthesis is impaired by a feedback mechanism.…”

“…This made the authors conclude that it is not yet possible to conclude whether PS is neutral, antiatherogenic or proatherogenic, and suggested the need for further investigation. A difficulty in associating the PS plasma concentration with CAD is that several epidemiological studies (39,47,48,54,56,61,(63)(64)(65)67) did not evaluate PS consumption but only assessed plasma PS measurements. Unfortunately, there are no studies on the effect of long-term supplementation on cardiovascular outcomes.…”

Plant Sterols Lower Cholesterol, but Increase Risk for Coronary Heart Disease

“…Most recently, Silbernagel et al (2010) studied 1,257 individuals in the Ludwigshafen Risk and Cardiovascular health (LURIC) study. They found that high absorption of phytosterols and concomitant low synthesis of cholesterol predicted increased all-cause and cardiovascular mortality in LURIC participants.…”