Phytosterol plasma concentrations and coronary heart disease in the prospective Spanish EPIC cohort.
J Lipid Res. 2009 Sep 28. Epub 2009 Sep 28. PMID: 19786566
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, phytyosterol 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 to controls, cases had non-significantly 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. APOE 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.