title: Plasma plant sterols serve as poor markers of cholesterol absorption in man.
abstract: The validation of the use of plasma plant sterols as a marker of cholesterol absorption is frail. Nevertheless, plant sterol concentrations are routinely used to describe treatment-induced changes in cholesterol absorption. Their use has also been advocated as a clinical tool to tailor cholesterol-lowering therapy. Prior to wider implementation, however, the validity of plant sterols as absorption markers needs solid evaluation. Therefore, we compared plasma plant sterol concentrations to gold-standard stable isotope-determined cholesterol absorption. Plasma campesterol/TC concentrations (camp/TC) were measured in a population of 175 mildly hypercholesterolemic individuals (age: 59.7 ± 5.6 years; BMI: 25.5 ± 2.9 kg/m(2); LDL-C: 4.01 ± 0.56 mmol/l). We compared cholesterol absorption according to the plasma dual-isotope method in subjects with the highest camp/TC concentrations (N = 41, camp/TC: 2.14 ± 0.68 μg/mg) and the lowest camp/TC concentrations (N = 39, camp/TC: 0.97 ± 0.22 μg/mg). Fractional cholesterol absorption did not differ between the groups (24 ± 12% versus 25 ± 16%, P = 0.60), nor was it associated with plasma camp/TC concentrations in the total population of 80 individuals (β = 0.13; P = 0.30, adjusted for BMI and plasma triglycerides). Our findings do not support a relation between plasma plant sterol concentrations and true cholesterol absorption and, therefore, do not favor the use of these sterols as markers of cholesterol absorption. This bears direct consequences for the interpretation of earlier studies, as well as for future studies targeting intestinal regulation of cholesterol metabolism.
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. l.jakulj@amc.nl
authors.forename: Lily
authors.initials: L
authors.lastname: Jakulj
authors.forename: Hussein
authors.initials: H
authors.lastname: Mohammed
authors.forename: Theo H
authors.initials: TH
authors.lastname: van Dijk
authors.forename: Theo
authors.initials: T
authors.lastname: Boer
authors.forename: Scott
authors.initials: S
authors.lastname: Turner
authors.forename: Albert K
authors.initials: AK
authors.lastname: Groen
authors.forename: Maud N
authors.initials: MN
authors.lastname: Vissers
authors.forename: Erik S G
authors.initials: ES
authors.lastname: Stroes
mesh_terms: D002784:Cholesterol / Q000031:analogs & derivatives / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010840:Phytosterols / Q000097:blood*; D014280:Triglycerides / Q000097:blood
chemical_list: D010840:Phytosterols; D014280:Triglycerides; C021273:campesterol; D002784:Cholesterol