title: Markers of enhanced cholesterol absorption are a strong predictor for cardiovascular diseases in patients without diabetes mellitus.
abstract: OBJECTIVE
  Hypercholesterolemia is a major risk factor for cardiovascular disease (CVD), and diabetes mellitus and statin treatment affect cholesterol metabolism. The aim of the present study was to evaluate markers of cholesterol metabolism and determine their relationship with CVD in patients without diabetes mellitus who were not receiving statin treatment.
  
  
  METHODS
  In addition to conventional CVD risk factors, plasma levels of campesterol and sitosterol (indicators of cholesterol absorption) and lathosterol (an indicator of cholesterol synthesis) were determined in 835 consecutive patients referred for coronary angiography. Coronary artery disease was evaluated by coronary angiograms, carotid atherosclerosis and peripheral vascular disease were assessed by Doppler ultrasound, and cerebrovascular accidents and transient ischemic attacks were identified by medical history.
  
  
  RESULTS
  After excluding patients with known diabetes mellitus and those receiving statin treatment, 177 patients were included in the analysis. Compared to patients without CVDs (n=111), patients with concomitant CVDs (n=66) had a reduced lathosterol-to-cholesterol ratio (1.25±0.61 vs. 1.38±0.63, P<0.05) and an increased campesterol-to-cholesterol ratio (1.81±1.04 vs. 1.50±0.69, P<0.05), indicating that enhanced absorption and reduced synthesis of cholesterol is associated with CVD development. Logistic regression analysis including all established cardiovascular risk factors (age, sex, total cholesterol, arterial hypertension, body mass index and smoking) revealed that campesterol and the campesterol-to-cholesterol ratio were significant predictors of concomitant CVD in this patient population.
  
  
  CONCLUSIONS
  In patients without diabetes mellitus, markers of enhanced cholesterol absorption were a strong predictor for concomitant CVD.
authors.affiliation: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Saar, Germany. oweingartner@aol.com
authors.forename: Oliver
authors.initials: O
authors.lastname: Weingärtner
authors.forename: Dieter
authors.initials: D
authors.lastname: Lütjohann
authors.forename: Tim
authors.initials: T
authors.lastname: Vanmierlo
authors.forename: Stephanie
authors.initials: S
authors.lastname: Müller
authors.forename: Laureen
authors.initials: L
authors.lastname: Günther
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herrmann
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
authors.forename: Markus
authors.initials: M
authors.lastname: Herrmann
mesh_terms: D000042:Absorption; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism*; D002784:Cholesterol / Q000096:biosynthesis / Q000097:blood / Q000378:metabolism*; D017023:Coronary Angiography; D048909:Diabetes Complications / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism*; D005260:Female; D006706:Homeostasis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol