title: Intake of phytosterols from natural sources and risk of cardiovascular disease in the European Prospective Investigation into Cancer and Nutrition-the Netherlands (EPIC-NL) population.
abstract: BACKGROUND
  Phytosterols (PSs) are known to lower low-density lipoprotein cholesterol (LDL-C), an established risk factor for cardiovascular disease (CVD). Whether a high intake of PS reduces CVD risk is unknown. This observational study aimed to investigate the associations between intake of naturally occurring PSs, blood lipids and CVD risk.
  
  
  METHODS
  The study included 35,597 Dutch men and women, participating in the European Prospective Investigation into Cancer and Nutrition-the Netherlands (EPIC-NL) study. At baseline, intakes of naturally occurring PSs were estimated with a validated food frequency questionnaire and non-fasting blood lipids were measured. Occurrence of CVD, coronary heart disease (CHD) and myocardial infarction (MI) was determined through linkage with registries.
  
  
  RESULTS
  The average energy-adjusted PS intake at baseline was 296 mg/d (range: 83-966 mg/d). During 12.2 years of follow-up, 3047 CVD cases (8.6%) were documented. After adjustment for confounders, PS intake was not associated with risk of CVD, CHD or MI (p-value trend > 0.05); hazard ratios ranged from 0.90-0.99 for CVD, from 0.83-0.90 for CHD and from 0.80-0.95 for MI risk across quintiles of PS intake and were almost all non-significant. Higher PS intake was associated with lower total cholesterol (-0.06 mmol/l per 50 mg/d; p-value = 0.038) and lower LDL-C (-0.07 mmol/l; p-value = 0.007), particularly among men. In mediation analysis, LDL-C did not materially affect the association between PS intake and CVD risk.
  
  
  CONCLUSIONS
  In this population with a relatively narrow range of low naturally occurring PS intakes, intake of PS was not associated with reduced CVD risk despite lower LDL-C concentrations in men.
authors.affiliation: Unilever Research and Development Vlaardingen, the Netherlands.
authors.forename: Rouyanne T
authors.initials: RT
authors.lastname: Ras
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: Unilever Research and Development Vlaardingen, the Netherlands.
authors.forename: Elke A
authors.initials: EA
authors.lastname: Trautwein
authors.affiliation: Department of Public Health, Ghent University, Belgium Research Foundation-Flanders, Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sioen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
authors.forename: Geertje W
authors.initials: GW
authors.lastname: Dalmeijer
authors.affiliation: Unilever Research and Development Vlaardingen, the Netherlands.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Zock
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands J.Beulens@umcutrecht.nl.
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D016014:Linear Models; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010840:Phytosterols / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008055:Lipids; D010840:Phytosterols
keywords: Phytosterols; blood lipids; cardiovascular disease