J. Lipid Res.
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A more recent version of this article appeared on January 1, 2007

Papers In Press, published online ahead of print October 30, 2006
J. Lipid Res., doi:10.1194/jlr.M600371-JLR200
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Submitted on August 18, 2006
Revised on October 20, 2006
Accepted on October 27, 2006

Plasma levels of plant sterols and the risk of future coronary artery disease in apparently healthy men and women; the prospective EPIC-Norfolk population study

Sabine Pinedo, Maud N. Vissers, Klaus von Bergmann, Karim Elharchaoui, Dieter Lütjohann, Robert Luben, Nicholas J. Wareham, John J.P. Kastelein, Kay-Tee Khaw, and S. Matthijs Boekholdt

Department of Vascular Medicine, Academic Medical Center, Amsterdam

Corresponding Author: m.n.vissers{at}amc.uva.nl

Some studies have suggested that a modest increase of plant sterol levels is a risk factor for coronary artery disease (CAD). We studied the prospective relationship between levels of plant sterols and the risk of future CAD in apparently healthy subjects. A nested case-control study was performed in the prospective EPIC-Norfolk population study. We measured plasma levels of the plant sterols sitosterol and campesterol at baseline among 373 apparently healthy individuals in whom fatal or nonfatal CAD developed during 6 years follow-up. A total of 758 controls were matched by age, sex, and enrolment time. Sitosterol and campesterol concentrations did not differ between cases and controls (sitosterol: 0.21 vs. 0.21 mg/dL, p=0.1; campesterol: 0.31 vs. 0.32 mg/dL, p=0.5). The sitosterol to cholesterol ratio was significantly lower in cases than in controls (1.19 vs. 1.29 µg/mg; p=0.008, respectively) whereas the campesterol to cholesterol ratio did not differ significantly (1.78 vs. 1.88 µg/mg; p=0.1). Plant sterol concentrations correlated positively with cholesterol levels and inversely with body mass index, and triglyceride and lathosterol concentrations. Among individuals in the highest tertile of the sitosterol concentration, the unadjusted odds ratio (OR) for future CAD was 0.75 (95%CI: 0.56-1.01; p for linearity=0.05). After adjustment for traditional risk factors the OR was 0.79 (95%CI: 0.56-1.13; p=0.2). For the campesterol concentration, the unadjusted OR for future CAD was 0.95 (95%CI: 0.71-1.29; p=0.8) and the adjusted OR was 0.97 (95%CI: 0.68-1.39; p=0.9). In this large prospective study, higher levels of plant sterols, at least in the physiological range, do not appear to be adversely related to CAD in apparently healthy individuals.


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