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

• Published in: Journal of lipid research Vol. 51; no. 3; pp. 618 - 624
• Main Authors: Escurriol, Verónica, Cofán, Montserrat, Moreno-Iribas, Concepción, Larrañaga, Nerea, Martínez, Carmen, Navarro, Carmen, Rodríguez, Laudina, González, Carlos A., Corella, Dolores, Ros, Emilio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2010; American Society for Biochemistry and Molecular Biology; The American Society for Biochemistry and Molecular Biology; Elsevier
• Subjects: Adult; Aged; apolipoprotein E; campesterol; cardiometabolic risk; Case-Control Studies; cholesterol; Cohort Studies; Coronary Disease - blood; Coronary Disease - epidemiology; Diet; European Prospective Investigation into Cancer and Nutrition; Female; Humans; lathosterol; Male; Middle Aged; nested case-control study; Patient-Oriented and Epidemiological Research; Phytosterols - blood; plant sterols; Prospective Studies; Risk Factors; sitosterol; Spain; Spain; European Prospective Investigation into Cancer and Nutrition; cardiometabolic risk; plant sterols; sitosterol; apolipoprotein E; cholesterol; nested case-control study; lathosterol; campesterol
• ISSN: 0022-2275; 1539-7262
• DOI: 10.1194/jlr.P000471

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 nonsignificantly 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% confidence 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.