title: Cholesterol absorption and synthesis markers in individuals with and without a CHD event during pravastatin therapy: insights from the PROSPER trial.
abstract: Cholesterol homeostasis, defined as the balance between absorption and synthesis, influences circulating cholesterol concentrations and subsequent coronary heart disease (CHD) risk. Statin therapy targets the rate-limiting enzyme in cholesterol biosynthesis and is efficacious in lowering CHD events and mortality. Nonetheless, CHD events still occur in some treated patients. To address differences in outcome during pravastatin therapy (40 mg/day), plasma markers of cholesterol synthesis (desmosterol, lathosterol) and fractional cholesterol absorption (campesterol, sitosterol) were measured, baseline and on treatment, in the Prospective Study of Pravastatin in the Elderly at Risk trial participants with (cases, n = 223) and without (controls, n = 257) a CHD event. Pravastatin therapy decreased plasma LDL-cholesterol and triglycerides and increased HDL-cholesterol concentrations to a similar extent in cases and controls. Decreased concentrations of the cholesterol synthesis markers desmosterol (-12% and -11%) and lathosterol (-50% and -56%) and increased concentrations of the cholesterol absorption markers campesterol (48% and 51%) and sitosterol (25% and 26%) were observed on treatment, but the magnitude of change was similar between cases and controls. These data suggest that decreases in cholesterol synthesis in response to pravastatin treatment were accompanied by modest compensatory increases in fractional cholesterol absorption. The magnitude of these alterations were similar between cases and controls and do not explain differences in outcomes with pravastatin treatment.
authors: Cardiovascular Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA. nirupa.matthan@tufts.edu
authors: Nirupa R
authors: NR
authors: Matthan
authors: Nancy
authors: N
authors: Resteghini
authors: Michele
authors: M
authors: Robertson
authors: Ian
authors: I
authors: Ford
authors: James
authors: J
authors: Shepherd
authors: Chris
authors: C
authors: Packard
authors: Brendan M
authors: BM
authors: Buckley
authors: J Wouter
authors: JW
authors: Jukema
authors: Alice H
authors: AH
authors: Lichtenstein
authors: Ernst J
authors: EJ
authors: Schaefer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000819:agonists / Q000031:analogs & derivatives / Q000097:blood; D008076:Cholesterol, HDL / Q000819:agonists / Q000097:blood; D008078:Cholesterol, LDL / Q000037:antagonists & inhibitors / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D003897:Desmosterol / Q000037:antagonists & inhibitors / Q000097:blood; D005260:Female; D006706:Homeostasis / Q000187:drug effects / Q000502:physiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D010840:Phytosterols / Q000819:agonists / Q000097:blood; D017035:Pravastatin / Q000008:administration & dosage / Q000627:therapeutic use*; D012855:Sitosterols / Q000819:agonists / Q000097:blood; D014280:Triglycerides / Q000037:antagonists & inhibitors / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010840:Phytosterols; D012855:Sitosterols; D014280:Triglycerides; D003897:Desmosterol; C021273:campesterol; C025473:gamma-sitosterol; C001521:lathosterol; D002784:Cholesterol; D017035:Pravastatin