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Papers In Press, published online ahead of print February 1, 2009
J. Lipid Res., doi:10.1194/jlr.P800013-JLR200

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Journal of Lipid Research, Vol. 50, 334-341, February 2009
Copyright © 2009 by American Society for Biochemistry and Molecular Biology

Patient-Oriented and Epidemiological Research

The relationships of cholesterol metabolism and plasma plant sterols with the severity of coronary artery disease^1,

Guenther Silbernagel^*, Guenter Fauler, Wilfried Renner, Eva M. Landl, Michael M. Hoffmann, Bernhard R. Winkelmann^**, Bernhard O. Boehm and Winfried März^2,,,***

^* Division of Endocrinology, Diabetology, Nephrology, Vascular Disease, and Clinical Chemistry, Department of Internal Medicine, University of Tübingen, Tübingen, Germany
Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
Division of Clinical Chemistry, Department of Internal Medicine, University of Freiburg, Freiburg, Germany
^** Cardiology Group Frankfurt-Sachsenhausen, Frankfurt, Germany
Division of Endocrinology, Department of Internal Medicine, University of Ulm, Ulm, Germany
Department of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
^*** Synlab Center of Laboratory Diagnostics, Heidelberg, Germany

¹ Declaration of Helsinki: The study complies with the Declaration of Helsinki and to Title 45, US Code of Federal Regulations, Part 46, Protection of Human Subjects, Revised November 13, 2001, effective December 13, 2001.

The online version of this article (available at http://www.jlr.org) contains supplementary data in the form of a table.

Published, JLR Papers in Press, September 3, 2008.

² To whom correspondence should be addressed. e-mail: winfried.maerz{at}synlab.de

Changes in the balance of cholesterol absorption and synthesis and moderately elevated plasma plant sterols have been suggested to be atherogenic. Measuring cholestanol, lathosterol, campesterol, and sitosterol, we investigated the relationships of cholesterol metabolism and plasma plant sterols with the severity of coronary artery disease (CAD) in 2,440 participants of the Ludwigshafen Risk and Cardiovascular health (LURIC) study. The coronary status was determined by angiography, and the severity of CAD was assessed by the Friesinger Score (FS). An increase in the ratio of cholestanol to cholesterol was associated with high FS (P = 0.006). In contrast, a high ratio of lathosterol to cholesterol went in parallel with low FS (P < 0.001). Whereas the campesterol to cholesterol ratio significantly correlated with the FS (P = 0.026), the relationship of the sitosterol to cholesterol ratio with the FS did not reach statistical significance in the whole group. Increased campesterol, sitosterol, and cholestanol to lathosterol ratios were associated high FS (P < 0.001). To conclude, there is a modest association of high cholesterol absorption and low cholesterol synthesis with an increased severity of CAD. An atherogenic role of plasma plant sterols themselves, however, seems unlikely in subjects without sitosterolaemia.

Supplementary key words cholesterol absorption • cholesterol synthesis • phytosterols • campesterol • sitosterol • cholestanol • lathosterol

Abbreviations: ABCG5, ATP-binding cassette transporter G5; ABCG8, ATP-binding cassette transporter G8; ANOVA, analysis of variance; APOE, apolipoprotein E; BMI, body mass index; CAD, coronary artery disease; FS, Friesinger Score; GCMS, gas chromatography and mass spectrometry; GLM, general linear model; LURIC, Ludwigshafen risk and cardiovascular health

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