Phytosterol plasma concentrations and coronary heart disease in the prospective Spanish EPIC cohort.
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.
Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain.
Verónica
V
Escurriol
Montserrat
M
Cofán
Concepción
C
Moreno-Iribas
Nerea
N
Larrañaga
Carmen
C
Martínez
Carmen
C
Navarro
Laudina
L
Rodríguez
Carlos A
CA
González
Dolores
D
Corella
Emilio
E
Ros
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology*; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010840:Phytosterols / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain
D010840:Phytosterols