phytosterols and Coronary-Disease

Phytosterols are sterols found naturally in various oils from plants. Phytosterols compete with cholesterol for a place in the mixed micelles, needed for cholesterol absorption by the small intestine. As a result, cholesterol absorption, either from food or from bile salts is lowered by about 50%, leading to a towering of about 10% of blood cholesterol level, despite an increase in hepatic cholesterol synthesis. This reduction is achieved when phytosterols are given both as monotherapy, and in addition to statin therapy. The average Western diet contains about 400-800 mg of phytosterols per day, while the dose needed for lowering the blood cholesterol level is about 2-3 grams per day. Therefore, for the purpose of reducing blood cholesterol, they should be given either as phytosterol-enriched food or as supplements. The reduction in the level of LDL-choLesterol achieved with phytosterols may reduce the risk of coronary disease by about 25%. Hence, the American Heart Association recommended the consumption of phytosterols, as part of a balanced diet, for towering blood cholesterol levels.

Topics: American Heart Association; Anticholesteremic Agents; Cholesterol, LDL; Coronary Disease; Dietary Supplements; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Phytosterols; United States

The cholesterol-lowering effect of plant sterols was first discovered in the early 1950s. However, it is only recently that plant sterols have become clinically important, when advances in food-technology have made it possible to combine sterols with a variety of food products including margarines, yogurts, fruit juices and cereal bars. We review the clinical trial evidence of lipid-lowering efficacy of plant sterols and discuss their implications in routine clinical practice. To generate the evidence we searched the Pubmed database for English language literature, using relevant keywords and medical subject heading (MeSH) terms, and extracted the findings from recently published studies and meta-analyses on this topic. Our findings suggest that the short-term use of food supplements rich in plant sterols is a safe and effective strategy; to maximize the benefits of dietary and lifestyle therapy, either with or without statin therapy, among majority of dyslipidemic patients with need for additional lipid-lowering.

Topics: Anticholesteremic Agents; Cholesterol; Clinical Trials as Topic; Coronary Disease; Diet; Dietary Fats; Food; Humans; Phytosterols

Hypercholesterolemia is a major risk factor for cardiovascular disease. The HMG-CoA-reductase inhibitors, statins, reduce plasma cholesterol and, as a consequence, decrease cardiovascular morbidity and mortality. Data from a subgroup analysis of the 4-S Study, however, indicate that patients with high cholesterol absorption may not benefit from statin treatment. Furthermore, there is accumulating evidence that lower hepatic synthesis and higher intestinal absorption markers are associated with increased cardiovascular risk. Therefore, prospective clinical trials are needed to evaluate whether subjects with altered cholesterol homeostasis may benefit from treatment strategies that reduce cholesterol absorption in addition to statin treatment.

Topics: Absorption; Anticholesteremic Agents; Cardiovascular Diseases; Cholesterol; Coronary Disease; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Intestinal Mucosa; Liver; Phytosterols; Risk; Sterols

Coronary heart disease (CHD) is the leading cause of mortality worldwide. With increasingly urbanized lifestyles in developing countries and the aging populations, the major risk factors for CHD such as obesity, diabetes mellitus, and hypercholesterolemia are likely to increase in the future. In the current report, we reviewed the evidence on the effect of cholesterol lowering using pharmacological agents.. A PubMed/Medline systematic search was performed over the past 12 years (1998-2009 inclusive) and relevant papers written in the English language were selected. We used key phrases including, "risk factors for hypercholesterolemia," "management of hypercholesterolemia," "guidelines for management of hypercholesterolemia," and "pharmacological management of hypercholesterolemia.". There were a total of over 3500 reports. We selected key publications on the effect of cholesterol lowering using different pharmacological agents.. Several options exist with regards to pharmacological management of hypercholesterolemia. There is a substantial body of evidence to support the effect of a population shift towards a favorable risk profile, which has huge potential in reducing the burden of CHD globally.

Topics: Anticholesteremic Agents; Azetidines; Cholestyramine Resin; Coronary Disease; Drug Therapy, Combination; Evidence-Based Practice; Ezetimibe; Fatty Acids, Omega-3; Gemfibrozil; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Niacin; Patient Selection; Phytosterols; Practice Guidelines as Topic; Primary Prevention; Risk Assessment; Risk Factors; Risk Reduction Behavior; Secondary Prevention; Treatment Outcome

Hyperlipidemia is a risk factor for the development of coronary heart disease. Many patients decline prescription lipid-lowering agents and opt instead for supplements. Before any supplement can be routinely recommended it is crucial to examine the types of clinical trials that have been performed, the mechanism by which a supplement is felt to alter lipids, the population studied, potential adverse effects, and the possibility that investigators might be biased. Clinical trial evidence strongly supports the notion that both red yeast rice and plant stanols and sterols effectively lower low-density lipoprotein (LDL) cholesterol. Preliminary evidence supports the possibility that green tea catechins and black tea theaflavins may lower LDL. Data do not support an LDL-lowering claim for guggulipid, policosanol, or cinnamon. Finally, there is strong clinical trial evidence suggesting that marine omega-3 fatty acids lower triglycerides.

Topics: Anticholesteremic Agents; Cholesterol, LDL; Coronary Disease; Humans; Hyperlipidemias; Phytosterols; Risk Factors

Plant sterols are plant components that have a chemical structure similar to cholesterol except for the addition of an extra methyl or ethyl group; however, plant sterol absorption in humans is considerably less than that of cholesterol. In fact, plant sterols reduce cholesterol absorption and thus reduce circulating levels of cholesterol. Earlier studies that have tested the efficacy of plant sterols as cholesterol-lowering agents incorporated plant sterols into fat spreads. Later on, plant sterols were added to other food matrices, including juices, nonfat beverages, milk and yogurt, cheese, meat, croissants and muffins, and cereal and chocolate bars. The beneficial physiologic effects of plant sterols could be further enhanced by combining them with other beneficial substances, such as olive and fish oils, fibers, and soy proteins, or with exercise. The addition of plant sterols to the diet is suggested by health experts as a safe and effective way to reduce the risk of coronary heart disease.

Topics: Anticholesteremic Agents; Cholesterol; Coronary Disease; Dietary Fats; Humans; Phytosterols

Prompted by current dietary recommendations for the control of serum cholesterol to new targets to reduce the risk of coronary heart disease (CHD), and by the CHD risk reduction claims made for certain foods or food components, studies are now being undertaken using combinations of cholesterol-lowering foods in one diet (eg, a dietary portfolio) rather than single foods to achieve more effective dietary control of serum cholesterol. This approach has increased the potential relevance of dietary therapy and may yield nutrition strategies that bridge the gap between what is regarded as a good diet and drug therapy.

Topics: Cardiovascular Diseases; Cholesterol, LDL; Coronary Disease; Diet; Dietary Fiber; Food; Health Behavior; Humans; Hypercholesterolemia; Hyperlipidemias; Lipids; Nuts; Phytosterols; Risk Factors; Risk Reduction Behavior; Soy Foods

Recently, it has been questioned whether elevated levels of circulating plant sterols increase the risk of coronary heart disease (CHD). To date, no definitive conclusions regarding such a relationship have been reached, nor have there been any studies summarizing the factors that contribute to the observed elevations in plant sterol concentrations in plasma. Thus, the purpose of this review is to systematically compare the plant sterol levels of subjects from the general population and to describe factors that contribute to the variations observed. The question of whether elevated plasma concentrations of plant sterols are associated with an increased risk of CHD was also assessed. Results indicate that the key factors accounting for variations in circulating plant sterol concentrations include: apolipoprotein E phenotypes, ATP-binding cassette transporter polymorphisms, use of statin drugs, presence of metabolic syndrome, dietary intake of plant sterols, gender, and analytical techniques used in the measurement of plant sterols in the plasma. An analysis of the studies examining the relationship between circulating levels of plant sterols and CHD risk in non-sitosterolemic populations revealed no clear associations. Furthermore, it was shown that the above-mentioned factors play an important role in determining the levels of plant sterols in plasma. Since these factors may act as potential confounders, they must be controlled for before more solid conclusions can be reached.

Topics: Animals; Apolipoproteins E; ATP Binding Cassette Transporter, Subfamily G, Member 5; ATP Binding Cassette Transporter, Subfamily G, Member 8; ATP-Binding Cassette Transporters; Coronary Disease; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lipoproteins; Male; Mice; Phenotype; Phytosterols; Risk Factors; Sex Factors

Topics: Animals; Coronary Disease; Humans; Phytosterols; Risk Factors

To compare the efficacy and safety of plant sterols and stanols as well as policosanol in the treatment of coronary heart disease, as measured by a reduction in low-density lipoprotein cholesterol (LDL) levels.. Systematic review and meta-analysis of randomized controlled trials.. A total of 4596 patients from 52 eligible studies.. We searched MEDLINE, EMBASE, the Web of Science, and the Cochrane Library from January 1967-June 2003 to identify pertinent studies. Reduction of LDL levels was the primary end point; effects on other lipid parameters and withdrawal of study patients due to adverse effects were the secondary end points. Weighted estimates of percent change in LDL were -11.0% for plant sterol and stanol esters 3.4 g/day (range 2-9 g/day [893 patients]) versus -2.3% for placebo (769 patients) in 23 eligible studies, compared with -23.7% for policosanol 12 mg/day (range 5-40 mg/day [1528 patients]) versus -0.11% for placebo (1406 patients) in 29 eligible studies. Cumulative p values were significantly different from placebo for both (p<0.0001). The net LDL reduction in the treatment groups minus that in the placebo groups was greater with policosanol than plant sterols and stanols (-24% versus -10%, p<0.0001). Policosanol also affected total cholesterol, high-density lipoprotein cholesterol (HDL), and triglyceride levels more favorably than plant sterols and stanols. Policosanol caused a clinically significant decrease in the LDL:HDL ratio. Pooled withdrawal rate due to adverse effects and combined relative risk for patients who withdrew were 0% and 0.84, respectively (95% confidence interval [CI] 0.36-1.95, p=0.69), for plant sterols and stanols across 20 studies versus 0.86% and 0.31, respectively (95% CI 0.20-0.48, p<0.0001), for policosanol across 28 studies.. Plant sterols and stanols and policosanol are well tolerated and safe; however, policosanol is more effective than plant sterols and stanols for LDL level reduction and more favorably alters the lipid profile, approaching antilipemic drug efficacy.

Topics: Anticholesteremic Agents; Coronary Disease; Fatty Alcohols; Humans; Hyperlipidemias; Phytosterols; Randomized Controlled Trials as Topic; Sitosterols

Cardiovascular disease (CVD) is currently one of the major contributors to the global burden of disease. Combination treatments to promote a maximal reduction of the ratio between total cholesterol and high-density lipoprotein are currently the most effective way of preventing CVD. In this review, we assess the role of plant sterols and statins in CVD prevention. Statins have been used by millions of patients at high to moderate risk of CVD, while plant sterols are potentially available to whole populations in food products. The benefits and risks of each compound, as well as the combination, are discussed.

Topics: Animals; Anticholesteremic Agents; Cholesterol; Clinical Trials as Topic; Coronary Disease; Drug Therapy, Combination; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Molecular Structure; Phytosterols

It has been difficult to identify the appropriate bioactive substance for the development of new functional foods associated with coronary heart disease, because the results of many clinical studies are contradictory.. The objective of this study was to use the multivariate statistical approach known as principal component analysis (PCA) followed by a mixed model to process data obtained from a meta-analysis aimed at evaluating simultaneously the effect of ingestion of 1 of 3 types of bioactive substances (n-3 fatty acids, soluble fibers, and phytosterols) on 1 or more of 4 biomarkers (plasma total cholesterol, triacylglycerol, LDL cholesterol, and HDL cholesterol).. Five independent variables (number of patients per study, dose, age, body mass index, and treatment length) and 4 dependent variables (percentage change in blood total cholesterol, LDL, HDL, and triacylglycerol) from 159 studies and substudies were organized into a matrix. The original values were converted to linear correlation units, which resulted in a new matrix.. Two principal components were enough to explain 63.73% and 84.27% of the variance in the independent and dependent variables, respectively. Phytosterols and soluble fibers had a hypocholesterolemic effect, whereas n-3 fatty acids lowered triacylglycerol and increased total, LDL, and HDL cholesterol. The PCA and mixed model showed that this behavior was independent of dose, number of patients per study, age, and body mass index but was associated with treatment length.. PCA is useful for summarizing available scientific information in examinations of health claims for foods and supplements.

Topics: Cholesterol; Coronary Disease; Dietary Fiber; Fatty Acids, Omega-3; Humans; Phytosterols; Triglycerides

Phytosterols and omega-3 fatty acids (n-3) are natural food ingredients with potential cardiovascular benefits. Phytosterols inhibit cholesterol absorption, thereby reducing total cholesterol (TC) and LDL-cholesterol levels. Numerous clinical studies have shown that a daily intake of 1.5-2.0 g of phytosterols can result in a 10-15 % reduction in LDL levels, while consumption of n-3 is associated with a significant reduction in plasma triglyceride (TG) concentrations. Furthermore, n-3 may also beneficially modify a number of other risk factors of coronary heart disease (CHD). Thus, it is reasonable to suggest that combination of phytosterols and n-3 may further reduce cardiovascular risk factors. Esterification of phytosterols with non-n-3 fatty acids has substantially improved their incorporation into a variety of foods without affecting the efficacy of phytosterols. Therefore, it is assumed that esterification of phytosterols with n-3 may have advantages for both food industry and health. Evidence suggests that this combination is effective in reducing the levels of several cardiovascular risk factors including TC and TG concentrations, pro-aggregatory factors, arrhythmic eicosanoid and thromboxane A2 levels. In this mini-review, we have critically reviewed and summarized data from clinical and animal studies in which phytosterols and n-3, alone or in combination, were used. We have also provided information on structure-function relationship for these two natural compounds. Biological properties of several phytosterol derivatives including phytosterol-glucoside have been also discussed. Although the animal studies are supportive of this combination therapy, human studies are needed to address its long term effects.

Topics: Animals; Anticholesteremic Agents; Cardiotonic Agents; Clinical Trials as Topic; Coronary Disease; Dose-Response Relationship, Drug; Drug Therapy, Combination; Fatty Acids, Omega-3; Humans; Phytosterols; Structure-Activity Relationship

Topics: Arachis; Coronary Disease; Fatty Acids, Monounsaturated; Health Promotion; Humans; Menu Planning; Neoplasms; Phytosterols; Resveratrol; Stilbenes; Stroke

Phytosterols (plant sterols) are triterpenes that are important structural components of plant membranes, and free phytosterols serve to stabilize phospholipid bilayers in plant cell membranes just as cholesterol does in animal cell membranes. Most phytosterols contain 28 or 29 carbons and one or two carbon-carbon double bonds, typically one in the sterol nucleus and sometimes a second in the alkyl side chain. Phytostanols are a fully-saturated subgroup of phytosterols (contain no double bonds). Phytostanols occur in trace levels in many plant species and they occur in high levels in tissues of only in a few cereal species. Phytosterols can be converted to phytostanols by chemical hydrogenation. More than 200 different types of phytosterols have been reported in plant species. In addition to the free form, phytosterols occur as four types of "conjugates," in which the 3beta-OH group is esterified to a fatty acid or a hydroxycinnamic acid, or glycosylated with a hexose (usually glucose) or a 6-fatty-acyl hexose. The most popular methods for phytosterol analysis involve hydrolysis of the esters (and sometimes the glycosides) and capillary GLC of the total phytosterols, either in the free form or as TMS or acetylated derivatives. Several alternative methods have been reported for analysis of free phytosterols and intact phytosteryl conjugates. Phytosterols and phytostanols have received much attention in the last five years because of their cholesterol-lowering properties. Early phytosterol-enriched products contained free phytosterols and relatively large dosages were required to significantly lower serum cholesterol. In the last several years two spreads, one containing phytostanyl fatty-acid esters and the other phytosteryl fatty-acid esters, have been commercialized and were shown to significantly lower serum cholesterol at dosages of 1-3 g per day. The popularity of these products has caused the medical and biochemical community to focus much attention on phytosterols and consequently research activity on phytosterols has increased dramatically.

Topics: Animals; Anticholesteremic Agents; Antioxidants; Coronary Disease; Food Analysis; Humans; Intestinal Absorption; Neoplasms; Phytosterols; Plants; Triterpenes

The Third Report of the National Cholesterol Education Program's Adult Treatment Panel (ATP III) has an extensive section on nonpharmacologic therapy for those with abnormal blood lipids. ATP III focused on the high-saturated fat atherogenic diet, obesity, and sedentary lifestyle and recommended a program of therapeutic lifestyle change (TLC). This review discusses several issues, including 1) why ATP III changed from the Step I and Step II diets to TLC; 2) the benefits of keeping trans fatty acid intake low and the addition of viscous fiber and plant stanol/sterol esters to reduce low-density lipoprotein cholesterol beyond that seen with the Step II diet; 3) the de-emphasis on total fat and a sharper focus on the kinds of fat ingested in the new guidelines; 4) the endorsement of regular physical activity and weight loss as important first steps in reversing the unwanted metabolic effects of the metabolic syndrome; and 5) the emphasis of health-promoting aspects of the diet that include, among other things, fish and omega-3 fatty acids. At all stages of TLC, ATP III encourages the referral to registered dietitians or other qualified nutritionists for medical nutrition therapy. TLC and the ATP III guidelines should provide guidance to practitioners who wish to get low-density lipoprotein cholesterol to goal (whether or not drugs are used), prevent or treat the metabolic syndrome, and improve the overall health of the patient.

Topics: Coronary Disease; Dietary Fiber; Fatty Acids; Humans; Life Style; Phytosterols

Topics: Anticholesteremic Agents; Cholesterol, LDL; Coronary Disease; Diet, Fat-Restricted; Feeding Behavior; Humans; Hypercholesterolemia; Nutritional Requirements; Phytosterols; Practice Guidelines as Topic; Risk Reduction Behavior; United States

Epidemiological studies, and some clinical trials, demonstrate that a proper diet reduces the rate of occurrence of cardiovascular disorders. Several in vitro studies suggest that some components of plant foods, most of which sharing a phenolic structure, are endowed with interesting 'pharmacological activities'. This article reviews the evidence that links a high dietary intake of phytochemicals from various sources with a reduced incidence of coronary heart disease.

Topics: Cacao; Coronary Disease; Diet; Dietary Supplements; Food, Fortified; Glycine max; Humans; Incidence; Olive Oil; Phenols; Phytosterols; Plant Oils; Plants, Edible; Tea; Wine

During the last decade, lipid lowering agents, in particular statins, have become increasingly important in the treatment of cardiovascular diseases and dyslipidaemias. This might imply that emphasis on diet and supplementary nutrients do not receive sufficient attention.. On the basis of studies of the literature, the scientific documentation for a possible beneficial effect of the following elements are reviewed: intake of fat, fish and fish oil, alpha-linolenic acid, folic acid, vitamin B6 and vitamin B12, nuts, plant sterols and psyllium.. Reduced intake of saturated fat causes improvement in serum lipid values and prevents cardiovascular events. Intake of fish, fish oils and alpha-linolenic acid has positive effects on several clinical end points, often without marked decrease in serum cholesterol. Homocysteine appears to be an independent risk factor for cardiovascular diseases, but a causal relationship remains to be proven. The cofactors folic acid, vitamin B6 and B12 reduce the homocysteine level, but effects of this intervention on hard clinical end points are lacking. There are indications that intake of nuts can prevent coronary events. Plant sterols and psyllium in the diet reduce cholesterol levels.. Thus, dietary intervention is important in the prevention and treatment of coronary heart disease. Also when drug treatment is indicated, a focus on diet and nutrient supplementation is highly warranted. Some nutrients may have preventive effect in relation to coronary events, despite their small effect on cholesterol levels.

Topics: Coronary Disease; Dietary Fats; Dietary Supplements; Feeding Behavior; Female; Fish Oils; Folic Acid; Homocysteine; Humans; Lipoproteins; Male; Nutritional Physiological Phenomena; Nuts; Phytosterols; Pyridoxine; Randomized Controlled Trials as Topic; Risk Factors; Vitamin B 12

Topics: Cacao; Cholesterol; Cholesterol, Dietary; Coronary Disease; Dietary Fats; Evaluation Studies as Topic; Fatty Acids; Fatty Acids, Essential; Fatty Acids, Unsaturated; Helianthus; Humans; Hydrogenation; Hypercholesterolemia; Male; Mathematics; Oils; Phytosterols; Seeds; Structure-Activity Relationship; Zea mays

Cholesterol homeostasis, defined as the balance between absorption and synthesis, influences circulating cholesterol concentrations and subsequent coronary heart disease (CHD) risk. Statin therapy targets the rate-limiting enzyme in cholesterol biosynthesis and is efficacious in lowering CHD events and mortality. Nonetheless, CHD events still occur in some treated patients. To address differences in outcome during pravastatin therapy (40 mg/day), plasma markers of cholesterol synthesis (desmosterol, lathosterol) and fractional cholesterol absorption (campesterol, sitosterol) were measured, baseline and on treatment, in the Prospective Study of Pravastatin in the Elderly at Risk trial participants with (cases, n = 223) and without (controls, n = 257) a CHD event. Pravastatin therapy decreased plasma LDL-cholesterol and triglycerides and increased HDL-cholesterol concentrations to a similar extent in cases and controls. Decreased concentrations of the cholesterol synthesis markers desmosterol (-12% and -11%) and lathosterol (-50% and -56%) and increased concentrations of the cholesterol absorption markers campesterol (48% and 51%) and sitosterol (25% and 26%) were observed on treatment, but the magnitude of change was similar between cases and controls. These data suggest that decreases in cholesterol synthesis in response to pravastatin treatment were accompanied by modest compensatory increases in fractional cholesterol absorption. The magnitude of these alterations were similar between cases and controls and do not explain differences in outcomes with pravastatin treatment.

Topics: Aged; Aged, 80 and over; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Coronary Disease; Desmosterol; Female; Homeostasis; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Phytosterols; Pravastatin; Sitosterols; Triglycerides

CHD is the leading cause of worldwide mortality. The prevalence of heart disease has been linked to the adoption of a sedentary lifestyle and the increased dietary dependence on saturated fats from animal sources and the intake of refined foods. Elevated blood cholesterol level is one of the major risk factors for CHD. While cholesterol-lowering drug therapy (statins) has been effective in reducing the risk of heart disease, there are those individuals who are unwilling or because of muscle pains or raised levels of liver or muscle enzymes are unable to take cholesterol-lowering medication. Fortunately, there is evidence linking a number of dietary components to CHD risk reduction. The strength of this evidence has prompted various regulatory bodies to advocate diet as the first line of defence for primary prevention of heart disease. It was therefore decided to combine four dietary components that have been shown to lower blood cholesterol concentrations (nuts, plant sterols, viscous fibre and vegetable protein) in a dietary portfolio in order to determine whether the combined effect is additive. In a metabolically-controlled setting this dietary portfolio has proved to be as effective as a starting dose of a first-generation statin cholesterol-lowering medication in reducing the risk of CHD. The dietary portfolio has also been shown to be effective in sustaining a clinically-significant effect in the long term under a 'real-world' scenario. However, success of the diet depends on compliance and despite the accessibility of the foods adherence has been found to vary greatly. Overall, the evidence supports the beneficial role of the dietary portfolio in reducing blood cholesterol levels and CHD risk.

Topics: Cholesterol; Coronary Disease; Diabetes Mellitus; Diet; Dietary Fiber; Dietary Proteins; Female; Humans; Male; Neoplasms; Nuts; Phytosterols; Phytotherapy; Plant Proteins; Risk Factors; Vegetables

We studied changes in serum cholestanol and plant sterols (indexes of cholesterol absorption) and cholesterol precursors (indexes of cholesterol synthesis) in response to cholesterol reduction by way of 1 year's treatment with atorvastatin (n = 102) and simvastatin (n = 105) treatments in patients with coronary heart disease. Serum cholesterol levels and ratios of the precursor sterols to cholesterol after 1 year of treatment were reduced in proportion to the pretreatment values (33% +/- 1% by simvastatin and 36% +/- 1% by atorvastatin; P <.01 for difference between groups) for cholesterol; the respective reductions in the precursor sterol:cholesterol ratios were also higher with atorvastatin (50% +/- 2% for lathosterol) than with simvastatin (42% +/- 1%; P <.01 between groups), but the ratio of squalene to cholesterol was increased (17% +/- 5%, P <.001) by atorvastatin. Plant sterol concentrations were gradually increased by atorvastatin but decreased initially by simvastatin. However, their ratios with respect to cholesterol were increased by as much as 82% with atorvastatin and by as much as 39% with simvastatin. In conclusion, effective inhibition of cholesterol synthesis and subsequent reduction in serum cholesterol levels by statins lead to increases in serum plant-sterol levels, probably as a result of reduced biliary secretion and enhanced absorption of these sterols. Because serum plant sterols have been claimed to be involved in the early development of atherosclerosis, the question arises whether continuously increasing serum plant sterols during long-term statin treatment should be prevented by cholesterol malabsorption (eg, by plant stanol ester consumption), especially in subjects with high baseline plant sterol values and effective sterol absorption.

Topics: Anticholesteremic Agents; Atorvastatin; Cholestanol; Cholesterol; Coronary Disease; Female; Heptanoic Acids; Humans; Male; Middle Aged; Phytosterols; Pyrroles; Simvastatin; Sitosterols; Squalene; Sterols

Coronary patients with low baseline ratios of serum cholestanol and plant sterols to cholesterol (indicating low cholesterol absorption) but not those with high ratios (high absorption) experienced reduced recurrences of coronary events during simvastatin treatment in the Scandinavian Simvastatin Survival Study. Thus, in the present study, serum cholesterol, its precursor sterols (reflecting cholesterol synthesis), plant sterols (campesterol and sitosterol), and cholestanol were measured before and during a 5-year period of placebo treatment (n=433) and simvastatin treatment (n=434) in patients from a subgroup of the Scandinavian Simvastatin Survival Study to determine whether changes in cholesterol synthesis and serum levels were related to cholesterol absorption. Serum cholesterol level was unchanged, the ratios of cholesterol precursor sterols to cholesterol were decreased, and the ratios of plant sterols to cholesterol were increased in relation to increasing baseline ratios of cholestanol quartiles. The latter predicted 5-year ratios and simvastatin-induced reductions of the precursor sterols, with the lowering of the ratios (cholesterol synthesis reduction) being almost twice higher in the lowest versus the highest quartile. The ratios of plant sterols, especially campesterol, to cholesterol were markedly increased during simvastatin treatment, mostly in subjects with the highest baseline cholestanol quartiles. Simvastatin reduced serum cholesterol more (P=0.003) in the lowest versus the highest cholestanol quartile during the 5-year treatment period. The results show for the first time that baseline cholesterol metabolism, measured by serum noncholesterol sterols, predicts the effectiveness of simvastatin in reducing cholesterol synthesis and serum levels of cholesterol. The drug suppresses the synthesis of cholesterol markedly more effectively in subjects with high than with low baseline synthesis but reduces respective serum cholesterol levels less markedly than synthesis. Subjects with high cholesterol absorption and low synthesis may need a combination therapy to lower more effectively their serum cholesterol levels and prevent an increase in the levels of plant sterols.

Topics: Anticholesteremic Agents; Body Weight; Cholestanol; Cholesterol; Coronary Disease; Desmosterol; Humans; Phytosterols; Placebos; Simvastatin; Sitosterols; Sterols

The plant-based Portfolio dietary pattern includes recognized cholesterol-lowering foods (ie, plant protein, nuts, viscous fiber, phytosterols, and plant monounsaturated fats) shown to improve several cardiovascular disease (CVD) risk factors in randomized controlled trials. However, there is limited evidence on the role of long-term adherence to the diet and CVD risk. The primary objective was to examine the relationship between the Portfolio Diet Score (PDS) and the risk of total CVD, coronary heart disease (CHD), and stroke.. We prospectively followed 73 924 women in the Nurses' Health Study (1984-2016), 92 346 women in the Nurses' Health Study II (1991-2017), and 43 970 men in the Health Professionals Follow-up Study (1986-2016) without CVD or cancer at baseline. Diet was assessed using validated food frequency questionnaires at baseline and every 4 years using a PDS that positively ranks plant protein (legumes), nuts and seeds, viscous fiber sources, phytosterols (mg/day), and plant monounsaturated fat sources, and negatively ranks foods high in saturated fat and cholesterol.. During up to 30 years of follow-up, 16 917 incident CVD cases, including 10 666 CHD cases and 6473 strokes, were documented. After multivariable adjustment for lifestyle factors and a modified Alternate Healthy Eating Index (excluding overlapping components), comparing the highest with the lowest quintile, participants with a higher PDS had a lower risk of total CVD (pooled hazard ratio [HR], 0.86 [95% CI, 0.81-0.92];. The PDS was associated with a lower risk of CVD, including CHD and stroke, and a more favorable blood lipid and inflammatory profile, in 3 large prospective cohorts.

Topics: Cardiovascular Diseases; Cholesterol; Coronary Disease; Diet; Female; Follow-Up Studies; Humans; Male; Phytosterols; Plant Proteins; Prospective Studies; Risk Factors; Stroke

Coronary heart disease (CHD) is one of the leading causes of mortality in many low-income and middle-income countries, including Indonesia, with elevated blood cholesterol level being one of significant risk factors for this condition. The problem should be addressed by combining healthy lifestyle and diet, where functional foods having a cholesterol-lowering activity could play a significant role. A group of compounds that had been proven to show cholesterol-lowering ability are plant sterols. To develop more suitable functional foods that could substantially contribute to hypercholesterolemia prevention in Indonesian population, up-to-date data about plant sterols dietary intake are required, and were not available until this research was done. This study aimed to estimate daily plant sterols intake and to determine the consumption pattern of foods containing plant sterols in rural and urban area of Bogor, West Java, Indonesia. The research was conducted with a cross-sectional design, with 200 respondents. The study revealed that the level of plant sterols intake in Bogor reached on average 229.76 mg/day and was not significantly different between urban and rural area. Cereals, vegetables, and fruit products were the main food sources of plant sterols in both areas. In addition, a list of several surveyed food items possible to be enriched with plant sterols was developed within the study. These results provide baseline data to develop functional foods fortified with plant sterols suitable for the Indonesian needs and taste. However, further studies are needed to confirm efficacy and safety of introducing such phytosterol-enriched products into a habitual diet, especially considering possible long-term side effects of plant sterol treatment.

Topics: Adult; Aged; Anticholesteremic Agents; Cholesterol; Coronary Disease; Cross-Sectional Studies; Diet; Diet Surveys; Eating; Feeding Behavior; Female; Food Ingredients; Food, Fortified; Functional Food; Humans; Hypercholesterolemia; Indonesia; Male; Middle Aged; Phytosterols

Topics: Anticholesteremic Agents; Cholesterol; Coronary Disease; Dietary Fats; Humans; Phytosterols

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.

Topics: Adult; Aged; Case-Control Studies; Cohort Studies; Coronary Disease; Diet; Female; Humans; Male; Middle Aged; Phytosterols; Prospective Studies; Risk Factors; Spain

The aim of the present study was to evaluate the role of cholesterol metabolism in the development of atheromatous artery disease.. Serum synthesis (cholesterol precursors) and absorption markers (cholestanol, campesterol, sitosterol, and avenasterol) were related to coronary risk factors and vascular structure in a population-based sample of 468 randomly selected 33-39-year-old men on their regular habitual diet. Carotid artery intima-media thickness (IMT) and serum lipids (including cholesterol) and sterols were measured in 2001, and the subjects were ranked to decreasing cholesterol synthesis depicted by serum cholestanol quartiles defined 21 years earlier in adolescence.. Serum cholesterol was correlated with absorption (e.g. serum campesterol, p<0.05), but not with synthesis, or with cholestanol quartiles. Cholesterol metabolism (synthesis/absorption markers) decreased linearly (about 50%) with the increasing cholestanol quartiles. IMT differed between the age groups, but not between cholestanol quartiles. Serum triglycerides, apoprotein B, and body mass index decreased, and non-HDL cholesterol/apoprotein B values increased between the cholestanol quartiles, whereas LDL cholesterol was unchanged. Cholesterol synthesis markers were related to blood pressure and serum triglycerides, and negatively to HDL cholesterol level in total population and in most of the cholestanol quartiles (p from 0.05 to 0.001).. Variables of metabolic syndrome accumulated in quartiles of high synthesis of cholesterol. Non-cholesterol sterols were related to many classic coronary risk factors, but virtually not to serum cholesterol or vascular structure.

Topics: Adolescent; Adult; Carotid Arteries; Child; Cholestanol; Cholesterol; Coronary Disease; Follow-Up Studies; Humans; Male; Phytosterols; Risk Factors; Sitosterols; Sterols; Tunica Intima; Tunica Media; Ultrasonography

Topics: Animals; Coronary Disease; Humans; Phytosterols; Risk

Statins reduce plasma plant sterol concentrations and, less consistently, their ratios to cholesterol in short-term studies. They most likely accomplish this by decreasing their transport protein levels. In long-term treatment with large doses of effective statins, serum plant sterol concentrations and frequently their ratios to cholesterol are consistently increased, especially with high, as opposed to low, baseline ratios. Enhanced intestinal absorption, decreased biliary secretion, and reversed cholesterol and plant sterol transport could explain these findings. However, statin treatment increases plant sterol ratios in serum and also in arterial plaques of endarterectomized patients. No trials of functional foods with plant sterols or stanols are available for coronary heart disease, even though their combination with statins effectively reduces low-density lipoprotein cholesterol. Plant sterols increase and plant stanols decrease serum plant sterols. Long-term statin treatment lowers coronary heart disease events only in patients with low baseline plant sterols who have high cholesterol synthesis. No convincing evidence is available that statin-induced phytosterolemia worsens atherosclerosis.

Topics: Cholesterol; Coronary Disease; Diet; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Phytosterols; Sitosterols

In postmenopausal coronary artery disease (CAD) women, serum plant sterols are elevated. Thus, we investigated further whether serum plant sterols reflect absolute cholesterol metabolism in CAD as in other populations and whether the ABCG5 and ABCG8 genes, associated with plant sterol metabolism, were related to the risk of CAD. In free-living postmenopausal women with (n = 47) and without (n = 62) CAD, serum noncholesterol sterols including plant sterols were analyzed with gas-liquid chromatography, cholesterol absorption with peroral isotopes, absolute cholesterol synthesis with sterol balance technique, and bile acid synthesis with quantitating fecal bile acids. In CAD women, serum plant sterol ratios to cholesterol were 21% to 26% (P < .05) higher than in controls despite similar cholesterol absorption efficiency. Absolute cholesterol and bile acid synthesis were reduced. Only in controls were serum plant sterols related to cholesterol absorption (eg, sitosterol; in controls: r = 0.533, P < .001; in CAD: r = 0.296, P = not significant). However, even in CAD women, serum lathosterol (relative synthesis marker) and lathosterol-cholestanol (relative synthesis-absorption marker) were related to absolute synthesis and absorption percentage (P range from .05 to <.001) similarly to controls. Frequencies of the common polymorphisms of ABCG5 and ABCG8 genes did not differ between coronary and control women. In conclusion, plant sterol metabolism is disturbed in CAD women; so serum plant sterols only tended to reflect absolute cholesterol absorption. Other relative markers of cholesterol metabolism were related to the absolute ones in both groups. ABCG5 and ABCG8 genes were not associated with the risk of CAD.

Topics: ATP Binding Cassette Transporter, Subfamily G, Member 5; ATP Binding Cassette Transporter, Subfamily G, Member 8; ATP-Binding Cassette Transporters; Bile Acids and Salts; Cholesterol; Cholesterol, Dietary; Coronary Angiography; Coronary Disease; Female; Humans; Intestinal Absorption; Lipoproteins; Middle Aged; Phytosterols; Polymorphism, Genetic; Polymorphism, Restriction Fragment Length; Postmenopause; Sterols

Hypercholesterolemia is a risk factor for aortic stenosis (AS) and for coronary artery disease (CAD). Serum cholesterol concentrations are determined by intestinal cholesterol absorption and endogenous cholesterol synthesis. Vascular effects of differences in cholesterol metabolism in patients with AS are so far unknown. Therefore, the aim of this study was to investigate differences in cholesterol metabolism in relation to vascular diseases in this subset of patients.. In addition to identifying conventional coronary risk factors, we determined plant sterols (indicators of cholesterol absorption) and lathosterol (indicator of cholesterol synthesis) levels in 40 consecutive men and women with AS. Coronary angiograms before the aortic valve replacement determined the extent of CAD.. Patients with a positive history of cardiovascular disease exhibited an increased campesterol-to-lathosterol ratio in plasma (P<0.005) and in aortic valve cusps (P<0.05). The plasma campesterol-to-lathosterol ratio increased with CAD severity (zero, single, two, three-vessel disease; P<0.05). Coronary vessel score strongly correlated with the campesterol-to-lathosterol ratio in plasma (r = 0.52; P<0.001) and in aortic valve cusps (r = 0.33; P<0.03). Logistic regression analysis revealed that the ratio of campesterol-to-lathosterol was the sole predictor of CAD among coronary risk factors tested (P<0.01).. Enhanced absorption and reduced synthesis of cholesterol is related to a positive family history of cardiovascular diseases and the development of concomitant CAD in patients with AS.

Topics: Adult; Aged; Aged, 80 and over; Aortic Valve Stenosis; Biomarkers; Cholesterol; Coronary Angiography; Coronary Disease; Cross-Sectional Studies; Female; Heart Valve Prosthesis Implantation; Homeostasis; Humans; Intestinal Absorption; Logistic Models; Male; Middle Aged; Phytosterols; Risk Assessment; Risk Factors; Severity of Illness Index; Ultrasonography

The role of statins in secondary prevention of cardiovascular disease is well established. However, there is debate about the most effective approach to primary prevention. This study simulated the effects of directed versus global approaches for intervention on coronary heart disease (CHD) event rates.. A primary prevention population was generated by computer simulation derived from data from the National Health Survey for England. The efficacy of reductions in cholesterol, treatment to cardiovascular risk targets and effects of phytosterols or statins were assessed.. A 0.5 mmol/L reduction in population total cholesterol would result in a 10.4% reduction in CHD events, while 1.0 mmol/L, 1.5 mmol/L and 2.0 mmol/L reductions would achieve 21.0%, 30.6% and 41.9% reductions respectively. In statin-based cardiovascular risk targeted strategies, use of simvastatin 40 mg would result in 1.8% reduction by UK National Service Framework targets of 30%/decade CHD risk and 7.2% reduction in events for a 20%/decade target assuming perfect adherence. Similarly, aggressive primary prevention with 40 mg atorvastatin would result in a 2.5% or 10% reduction in events. Universal use of 10 mg simvastatin following an over-the-counter approach would result in a 25% reduction in CHD events. In contrast, whole population consumption of sitostanol/sitosterol products would result in 11.8% reduction.. Targeting and treating high-risk individuals may be beneficial for them and rewarding for medical practitioners. However, this approach has minimal effects on the population burden of atherosclerotic disease. This study suggests that universal therapy with phytosterols and/or wider availability of statins has the potential to dramatically decrease rates of CHD.

Topics: Anticholesteremic Agents; Cholesterol; Computer Simulation; Coronary Disease; Cost-Benefit Analysis; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Nonprescription Drugs; Phytosterols; Primary Prevention; Risk Factors

Functional foods with supplementation of plant sterols are already used by millions of people. However, at the same time it is current scientific thinking that elevation of plant sterols in the circulation causes coronary heart disease. Therefore, this study aimed to define the risk for coronary heart disease associated with moderately high plant sterol plasma levels in a cohort of elderly. In this study, we evaluated the association between plant sterols and coronary heart disease in a cohort of 1242 subjects older than 65 years, participating at the Longitudinal Aging Study Amsterdam (LASA). Concentrations of sitosterol, campesterol, brassicasterol and stigmasterol were assessed using highly sensitive and specific gas chromatography-mass spectrometry-selected ion-monitoring. Plant sterol concentrations (and their ratios to cholesterol) were slightly, however, significantly lower in patients with coronary heart disease. Moreover, high plasma concentrations of a marker plant sterol, sitosterol, were associated with a markedly reduced risk for coronary heart disease (OR 0.78, CI 0.62-0.98, p<0.05). In contrast neither plant stanols (sitostanol or campestanol) nor the cholesterol synthesis markers (lathosterol, lanosterol and desmosterol) nor their ratios to cholesterol were significantly different in the study groups. These data suggest that plant sterols could have neutral or even protective effects on development of coronary heart disease, which have to be confirmed in interventional trials.

Topics: Aged; Aged, 80 and over; Cholesterol; Coronary Disease; Cross-Sectional Studies; Female; Humans; Logistic Models; Male; Peripheral Vascular Diseases; Phytosterols; Risk Factors; Sitosterols

Some studies have suggested that a modest increase of plant sterol levels is a risk factor for coronary artery disease (CAD). We studied the relationship between plant sterol levels and CAD risk in a prospective nested case-control study consisting of 373 cases and 758 controls. Sitosterol and campesterol concentrations did not differ between cases and controls [sitosterol, 0.21 vs. 0.21 mg/dl (P = 0.1); campesterol, 0.31 vs. 0.32 mg/dl (P = 0.5)]. The sitosterol-to-cholesterol ratio was significantly lower in cases than in controls (1.19 vs. 1.29 microg/mg; P = 0.008), whereas the campesterol-to-cholesterol ratio did not differ significantly (1.78 vs. 1.88 microg/mg; P = 0.1). Plant sterol concentrations correlated positively with cholesterol levels and inversely with body mass index and triglyceride and lathosterol concentrations. Among individuals in the highest tertile of the sitosterol concentration, the unadjusted odds ratio (OR) for future CAD was 0.75 [95% confidence interval (CI) = 0.56-1.01]. After adjustment for traditional risk factors, the OR was 0.79 (95% CI = 0.56-1.13). For the campesterol concentration, the unadjusted OR was 0.95 (95% CI = 0.71-1.29) and the adjusted OR was 0.97 (95% CI = 0.68-1.39). In this large prospective study, higher levels of plant sterols, at least in the physiological range, do not appear to be adversely related to CAD in apparently healthy individuals.

Topics: Aged; Body Mass Index; Case-Control Studies; Cholesterol; Coronary Disease; England; Female; Humans; Lipids; Male; Middle Aged; Netherlands; Phytosterols; Prospective Studies; Triglycerides

A dietary portfolio of cholesterol-lowering ingredients has proved effective in reducing serum cholesterol. However, it is not known whether this dietary combination will also affect hematologic risk factors for coronary heart disease (CHD). Reductions in hematocrit and polymorphonuclear leukocytes have been reported to improve cardiovascular risk. We, therefore, report changes in hematological indices, which have been linked to cardiovascular health, in a 1-year assessment of subjects taking an effective dietary combination (portfolio) of cholesterol-lowering foods.. For 12 months, 66 hyperlipidemic subjects were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal) and almonds (23 g/1000 kcal). Fifty-five subjects completed the study.. Over the 1 year, data on completers indicated small but significant reductions in hemoglobin (-1.5+/-0.6 g/l, P=0.013), hematocrit (-0.007+/-0.002 l/l, P<0.001), red cell number (-0.07+/-0.02 10(9)/l, P<0.001) and neutrophils (-0.34+/-0.13 10(9)/l, P=0.014). Mean platelet volume was also increased (0.16+/-0.07 fl, P=0.033). The increase in red cell osmotic fragility (0.05+/-0.03 g/l, P=0.107) did not reach significance.. These small changes in hematological indices after a cholesterol-lowering diet are in the direction, which would be predicted to reduce CHD risk. Further research is needed to clarify whether the changes observed will contribute directly or indirectly to cardiovascular benefits beyond those expected from reductions previously seen in serum lipids and blood pressure.

Topics: Adult; Aged; Aged, 80 and over; Cholesterol; Cholesterol, Dietary; Coronary Disease; Dietary Fiber; Erythrocyte Deformability; Female; Hematocrit; Humans; Hypercholesterolemia; Male; Middle Aged; Neutrophils; Phytosterols; Prunus; Risk Factors; Soybean Proteins

For decreasing the risk of coronary heart disease (CHD) it has been proposed to enrich food such as margarine with plant sterol esters which have been shown to reduce total and LDL cholesterol concentrations, two of the major risk factors. A Markov model was developed to assess the costs and benefits of consuming a low-fat plant sterol containing margarine (PS margarine). A health insurer's perspective was taken with a time frame of 10 years. Transition probabilities for CHD and CHD-related death were calculated on the basis of the Framingham risk equations. These were applied to a representative sample of the German population. The alteration in cholesterol levels after intake of PS margarine was estimated based on a meta-analysis of ten randomized controlled trials with parallel or crossover design that found a reduction of 5.7% in total cholesterol. Average annual costs of CHD were assumed to be at 3,000 euro. Costs for "no CHD" and "CHD-related death" were set to 0 euro since the intervention would solely be paid by the consumers. Sensitivity analyses were performed with regard to annual costs, risk estimation, PS margarine reduction in total cholesterol, discount factor, and risk of CHD-related death. The 10-year CHD risks are 6.1% (PS margarine) vs. 6.5% (control). Thus expected 10-year CHD costs are 696 euro (PS margarine) vs. 748 euro (control). The cost savings of 52 euro varied between 32 euro and 74 euro in the sensitivity analysis. A projection at the level of the population for which evidence (randomized controlled trials) exists that plant sterols lower cholesterol (25.35 million) leads to a reduction of 117,000 CHD cases over 10 years and a cost reduction of 1.3 billion euro for this time period (sensitivity analysis 0.8-1.9 billion euro).

Topics: Adolescent; Adult; Aged; Cholesterol; Coronary Disease; Cost-Benefit Analysis; Female; Humans; Male; Margarine; Markov Chains; Meta-Analysis as Topic; Middle Aged; Models, Econometric; Phytosterols; Randomized Controlled Trials as Topic; Risk Factors

Topics: Coronary Disease; Cost-Benefit Analysis; Female; Food, Fortified; Humans; Hyperlipidemias; Hypolipidemic Agents; Intestinal Absorption; Male; Margarine; Patient Compliance; Phytosterols; Safety; Treatment Outcome

Topics: Anticholesteremic Agents; Coronary Disease; Humans; Phytosterols

In patients with the inherited disease of phytosterolemia, elevated concentrations of plant sterols (eg, campesterol and sitosterol) have been implicated as a risk factor for premature atherosclerosis. Whether plasma concentrations of campesterol and sitosterol are risk factors for coronary heart disease (CHD) in nonphytosterolemia subjects has not been established. Therefore, the present study examined the role of plant sterols in patients admitted for elective artery coronary bypass graft (ACBG). Serum concentrations of campesterol and sitosterol, as well as lathosterol, desmosterol, cholestanol, and lipoproteins were analyzed in 42 men and 11 women without lipid-lowering treatment during the past. Twenty-six patients reported a positive family history in their first-degree relatives for CHD. Lipid profile and other risk factors were comparable in both groups. Patients with a positive family history for CHD had significant higher plasma levels of campesterol (.50 +/-.17 v.38 +/-.16 mg/dL; P =.011), sitosterol (.40 +/-.11 v.31 +/-.11 mg/dL; P =.004) and their ratios to cholesterol. Lathosterol, desmosterol, cholestanol, and their ratios to cholesterol were not significantly different. Analysis of covariance (ANCOVA) analysis showed no influence of sex, age, triglycerides, total-, low-density lipoprotein (LDL)-, and high-density lipoprotein (HDL)-cholesterol on the results, but confirmed a strong influence of plant sterols. These findings support the hypothesis that plant sterols might be an additional risk factor for CHD.

Topics: Aged; Cholesterol; Coronary Disease; Family; Female; Humans; Male; Medical Records; Middle Aged; Osmolar Concentration; Phytosterols; Risk Factors; Sitosterols

Considerable attention in the recent past has focused on the potential benefits or adverse effects of butter versus different types of margarines, usually with respect to their relative content of polyunsaturated, saturated, and trans fatty acids, and the impact of these on low-density lipoprotein (LDL) cholesterol levels. Recently, a new class of margarines and other fat-derived products (eg, salad dressings, mayonnaise) containing plant-derived sterols that are intended for use to lower blood cholesterol levels have been introduced into the food supply. These products are being marketed as adjuncts to low-saturated-fat and low-cholesterol diets to maximize reductions in LDL cholesterol levels achievable by dietary means.

Topics: American Heart Association; Cholesterol; Coronary Disease; Diet; Food; Humans; Margarine; Phytosterols; Risk Factors

Used as a substitute for normal dietary intake of saturated fatty acids, margarines containing plant sterols can cause a modest reduction in serum total cholesterol and low-density lipoprotein cholesterol levels. They have been shown effective in patients with mild hypercholesterolemia, but they are also useful in the general population.

Topics: Anticholesteremic Agents; Cholesterol; Cholesterol, LDL; Coronary Disease; Costs and Cost Analysis; Female; Humans; Hypercholesterolemia; Hyperlipidemias; Hypolipidemic Agents; Margarine; Phytosterols; Randomized Controlled Trials as Topic; Simvastatin; Sitosterols; Time Factors

The purpose of the study was to investigate whether cholesterol metabolism is associated with coronary artery disease (CAD) in postmenopausal women.. Although hypercholesterolemia, a predominant risk factor of CAD, is related to cholesterol metabolism, the association between cholesterol metabolism and CAD is not well known.. In addition to conventional coronary risk factors, fasting serum squalene, delta8-cholestenol, desmosterol, lathosterol (indicators of cholesterol synthesis), cholestanol, campesterol and sitosterol (indicators of cholesterol absorption) were measured in 48 50- to 55-year-old consecutive women with angiographically verified CAD and in 61 age-matched healthy controls.. The coronary patients had elevated ratios of squalene (p < 0.001), desmosterol (p = 0.005), campesterol (p = 0.028) and sitosterol (p = 0.022) to cholesterol, but had lower respective lathosterol value (p = 0.041) compared with the controls, despite similar serum cholesterol levels. Adjusted for age, body mass index, family history of CAD, smoking, hypertension, serum triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol level and glycosylated hemoglobin A1c% (GHbA1c), the ratios of squalene (odds ratio, 1.36; 95% confidence interval, 1.17 to 1.57), lathosterol (0.98; 0.97 to 0.99), campesterol (1.01; 1.00 to 1.01) and sitosterol (1.01; 1.00 to 1.03) were significantly associated with the risk of CAD. In addition, family history of CAD and GHbA1c% were also independently related to the presence of CAD.. The results suggest that women with elevated ratios of serum squalene, campesterol and sitosterol to cholesterol and low respective lathosterol values have enhanced risk for CAD. Thus, enhanced absorption and reduced synthesis of cholesterol may be related to coronary atherosclerosis.

Topics: Case-Control Studies; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Coronary Disease; Desmosterol; Fasting; Female; Glycated Hemoglobin; Humans; Middle Aged; Phytosterols; Postmenopause; Prevalence; Radiography; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Sitosterols; Squalene

The Food and Drug Administration (FDA) is authorizing the use, on food labels and in food labeling, of health claims on the association between plant sterol/stanol esters and reduced risk of coronary heart disease (CHD). FDA is taking this action in response to a petition filed by Lipton (plant sterol esters petitioner) and a petition filed by McNeil Consumer Healthcare (plant stanol esters petitioner). Based on the totality of publicly available evidence, the agency has concluded that plant sterol/stanol esters may reduce the risk of CHD.

Topics: Coronary Disease; Food Labeling; Humans; Hypercholesterolemia; Hypolipidemic Agents; Phytosterols; Risk Factors; United States; United States Food and Drug Administration

Topics: Cholesterol, LDL; Coronary Disease; Dietary Fats; Humans; Margarine; Phytosterols

Topics: Cholesterol; Cholesterol, Dietary; Coronary Disease; Dietary Fats; Humans; Phytosterols

Topics: Adult; Aortic Valve Stenosis; Coronary Disease; Humans; Male; Phytosterols

To assess relationships of serum phytosterols (plant sterols [P]) to serum cholesterol (C), P were measured by gas-liquid chromatography (GLC) in 595 hypercholesterolemics (top C quintile in screening of 3,472 self-referred subjects). A second specific aim was to determine whether high serum P would track over time and whether they would predict familial aggregation of high C, high low-density lipoprotein cholesterol (LDLC), high apolipoprotein (apo) B, and increased premature coronary heart disease (CHD) in hyperphytosterolemic probands and their first-degree relatives. Mean +/- (SD) C was 260 +/- 56 mg/dL, campesterol (CAMP) was 2.10 +/- 1.6 micrograms/mL, stigmasterol (STIG) 1.71 +/- 1.67, sitosterol (SIT) 2.98 +/- 1.61, and total P 6.79 +/- 3.66 micrograms/mL. Serum C correlated with CAMP (r = .15, P less than or equal to .001), STIG (r = .10, P less than or equal to .02), SIT (r = .34, P less than or equal to .0001), and total P (r = .29, P less than or equal to .0001). High serum CAMP and STIG were associated with a personal or family history of CHD in subjects less than or equal to age 55 years (premature CHD). In 21 hyperphytosterolemic probands who initially had at least one P at or above the 95th percentile and a second P at or above the 75th percentile, P were remeasured 2 years later. Initial and 2-year follow-up CAMP, STIG, and SIT did not differ (P greater than .7). Initial and follow-up CAMP were correlated (r = .47, P = .03).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aging; Cholesterol; Coronary Disease; Cyclic AMP; Female; Follow-Up Studies; Humans; Hyperlipoproteinemia Type II; Lipids; Lipoproteins; Male; Phytosterols; Sex Characteristics

We measured the cholestanol, cholesterol precursor (lathosterol), and plant sterol (campesterol and sitosterol) concentrations of serum and bile in 11 patients with cerebrotendinous xanthomatosis. The mean values of serum cholestanol, lathosterol, campesterol, and sitosterol were, respectively, 8.4-, 2.5-, 2.7-, and 1.4-times higher in the patients than in normal control subjects (n = 26). Cholestanol (6.7-fold) and campesterol (3.7-fold) levels in bile (n = 4) were also elevated in the patients. There was no significant difference of serum sterol levels between patients with coronary artery disease and those without it. Chenodeoxycholic acid treatment for periods ranging from 6 months to 3 years and 4 months lowered serum lathosterol (57.7% reduction) and campesterol (57.8%) levels in parallel with cholestanol (70.8%) level, but the sitosterol level (19.7%) decreased less. Thus, increased levels of cholesterol precursor (lathosterol), plant sterols (campesterol and sitosterol), and cholestanol were found in the serum and bile in cerebrotendinous xanthomatosis. Chenodeoxycholic acid treatment effectively reduced the levels of these sterols, except for sitosterol.

Topics: Adult; Bile; Chenodeoxycholic Acid; Cholestanol; Cholesterol; Chromatography, High Pressure Liquid; Coronary Disease; Female; Humans; Male; Middle Aged; Phytosterols; Sitosterols; Xanthomatosis

The dietary intake of cholesterol, phytosterol and PUFA in Japanese was investigated to obtain information on dietary parameters related to coronary artery disease. Three daily menus for both 1957 and 1982 were prepared based on the daily per capita consumption of foods and nutrient intakes from national surveys. From 1957 to 1982, the average daily intake of cholesterol rose 2.1-fold from 183 to 376 mg while that of phytosterol remained at about 373 mg. Daily intakes of total fatty acid (19.2 g), PUFA (7.3 g), MUFA (5.8 g) and SFA (6.1 g) in 1957 increased in 1982 to 48.7 g, 11.9 g, 19.5 g and 17.3 g, respectively. The ratio of PUFA/SFA decreased to 56% from 1.23 in 1957 to 0.69 in 1982 and the PUFA/MUFA ratio also decreased to 48%. The PUFA/cholesterol ratio was lower in 1982 (31.8) than in 1957 (42.6), and the decrease in the phytosterol/cholesterol ratio to 46% was greater than that in the PUFA/cholesterol ratio (which only fell to 75% of the 1957 value). Thus, comparison of the 1982 and 1957 intakes indicated the increase in risk factors, cholesterol and SFA intake, and the decrease in the ratio of PUFA/SFA in the Japanese population during the past few decades.

Topics: Cholesterol, Dietary; Coronary Disease; Dietary Fats; Energy Intake; Fatty Acids; Fatty Acids, Unsaturated; Humans; Japan; Phytosterols

Hypolipidemic therapy should be developed as a therapy aimed at the normalization of metabolism since the functional relationship of lipid and carbohydrate metabolism is evident both in normal and pathological conditions. The results of the reaction of the lipid spectrum of the blood to a single glucose load confirms that patients with combined hyperlipoproteinemias (IIb type) are heterogeneous in terms of the pathogenesis of the metabolic disturbances which should be taken into account in assessing the efficiency of hypolipidemic drugs as well as in selecting and administering medicines.

Topics: Coronary Disease; Drug Evaluation; Glucose Tolerance Test; Humans; Hyperlipoproteinemias; Hypolipidemic Agents; Lipids; Lipoproteins; Phytosterols; Probucol

The lipid hypothesis stipulates that the risk of developing CAD is related to the cholesterol levels of various lipoprotein fractions, the risk increasing with either a higher LDL cholesterol level or a lower HDL cholesterol level. The data reviewed here indicate that the measurement of the plasma level of the major apoproteins of LDL and HDL, apoB and apoA-I, respectively, provide additional information in the assessment of a patient at risk for CAD. In the case of LDL B, two "normocholesterolemic" groups with CAD are detected, those with normotriglyceridemic HyperapoB and those with hypertriglyceridemic HyperapoB . In all of these syndromes associated with premature CAD, HyperapoB , FCH, and FH, the common denominator is an increased number of LDL particles. A low level of apoA-I may indicate that one of the subfractions of HDL (HDL2) is decreased. HDL2 is generally decreased in disorders where LDL B is elevated, a combination that may be particularly atherogenic. Conversely, elevated apoA-I and HDL cholesterol levels, or decreased LDL cholesterol and LDL B protein levels, are associated with a low prevalence of CAD and longevity. Thus, LDL and HDL levels may be metabolically linked, a relation which is more evident if apoproteins are measured and which may be obscured if apoproteins are not determined. The assessment of dyslipoproteinemia in a patient at risk for CAD might optimally include measurement of LDL B and apoA-I levels, in addition to LDL cholesterol and HDL cholesterol levels.

Topics: Adult; Apolipoprotein A-I; Apolipoproteins; Apolipoproteins B; Arteriosclerosis; Child; Cholesterol; Cholesterol, LDL; Coronary Disease; Female; Humans; Hyperlipidemia, Familial Combined; Lipoproteins, HDL; Lipoproteins, LDL; Male; Middle Aged; Myocardial Infarction; Phytosterols; Triglycerides

The death of a 13-year-old boy from coronary atherosclerosis prompted the study of an Amish family. Five of his twelve sibs had tendon and tuberous xanthomas, and increased plasma plant sterols, particularly beta-sitosterol. The plasma level of the major apoprotein of low density lipoprotein (LDL), the B protein, was very high (mean 173 mg/dl) in these five sibs, while the LDL cholesterol level was moderately increased (209 mg/dl). Four other sibs and both parents had an increased LDL B protein level with a normal or mildly raised plasma total and LDL cholesterol level (hyperapobeta-lipoproteinaemia). Evidence for coronary artery disease was found in both parents and three xanthomatous sibs. The original family with beta-sitosterolaemia and xanthomatosis, described in 1974, was re-examined. The proband and her sister had persistent phytosterolaemia and normocholesterolaemia but increased LDL B protein levels. Both parents, two uncles, and three of four grandparents had increased LDL B protein levels and normal total and LDL cholesterol levels. The proband's father had atypical angina pectoris. People with the full syndrome (phytosterolaemia, xanthomas, and hyperapobetalipoproteinaemia) are most probably homozygous for a mutant allele. An increased LDL B protein level permits the identification of heterozygotes in these families, even though in the fasting state they show no phytosterolaemia. The homozygote and probably the heterozygote are at increased risk for cardiovascular atherosclerotic disease.

Topics: Adolescent; Adult; Coronary Disease; Female; Heterozygote; Homozygote; Humans; Hyperlipoproteinemia Type II; Lipoproteins, LDL; Male; Pedigree; Phytosterols; Xanthogranuloma, Juvenile

An adult Chinese man presented with tendinous and tuberous xanthomatosis and severe atheromatous changes in the coronary arteries. In addition, he had chronic hemolytic anemia, with spherostomatocytic erythrocytes. Cerebrotendinous xanthomatosis was diagnosed on the basis of increased cholestanol levels in his plasma, red cells and xanthoma, changes in bile acid composition due to the defective synthesis of chenodeoxycholic acid. Coexisting beta-sitosterolemia was confirmed by the finding of large amounts of the plant sterols such as beta-sitosterol and campesterol. This is the first report of these two rare lipid storage disorders in the same patient.

Topics: Adult; Anemia, Hemolytic; Chenodeoxycholic Acid; Cholestanols; Cholesterol; Coronary Disease; Humans; Lipidoses; Phytosterols; Sitosterols; Spherocytes; Xanthomatosis

A fourth case is described in which phytosterolaemia, earlier diagnosed as familial hypercholesterolaemia, was associated with normocholesterolaemia, hypersplenism and premature atherosclerotic arterial disease requiring a three-vessel coronary bypass at the age of 29 years. During a follow-up of 5 years 22-26% and 27-30% of serum and bile sterols were plant sterols, respectively. In addition to campesterol and beta-sitosterol, stigmasterol and a fourth major plant sterol, tentatively identified as avenasterol, were found in bile, and in free and esterified forms in all serum lipoproteins. Analysis of faecal steroids and measurement of biliary lipid secretion indicated that in addition to enhanced absorption of plant sterols their decreased biliary secretion contributed to the development of phytosterolaemia. Impaired biliary cholesterol secretion was compensated for by a markedly reduced cholesterol but normal bile acid synthesis and resulted in bile undersaturated with respect to cholesterol, in a reduced intestinal cholesterol pool and in a very low faecal excretion of cholesterol as neutral sterols. Cholestyramine brought about a modest increase in cholesterol elimination as bile acids, increased cholesterol synthesis as evidenced by the sterol balance value and the increased cholesterol precursors squalene and methyl sterols in plasma and bile, and reduced the plasma cholesterol by 21% and plant sterols by 16%, but had no effect on the biliary composition of main sterols.

Topics: Absorption; Adult; Arteriosclerosis; Bile; Bile Acids and Salts; Cholesterol; Cholestyramine Resin; Coronary Disease; Feces; Humans; Hypercholesterolemia; Hyperlipidemias; Lipid Metabolism; Lipoproteins; Male; Phytosterols; Squalene; Xanthomatosis

The data relating diet to coronary heart disease, when critically examined, clearly show that there is a normal spectrum of blood serum values, and that normal persons do not develop pathological levels upon the ingestion of eggs and other cholesterol-containing the ingestion of large amounts of cholesterol-containing foods. Average data obtained from mixed populations of normal and pathological blood lipid values should not be used to advise the normal majority of that population. The harmful effects of such policy are outlined. The data demonstrating the concept that the risk of coronary heart disease is a function of serum lipids at any level is no longer valid are reviewed. The data of the National Cooperative Pooling Project of the American Heart Association are used to show that up to 250 mg/dl there is no relationship between serum cholesterol concentration and risk.

Topics: Adolescent; Adult; Age Factors; Aged; American Heart Association; American Medical Association; Arteriosclerosis; Child; Child, Preschool; Cholesterol; Cholesterol, Dietary; Coronary Disease; Diet; Dietary Fats; Evaluation Studies as Topic; Fats, Unsaturated; Female; Humans; Hyperlipidemias; Infant; Infant, Newborn; Lipids; Male; Middle Aged; Phytosterols; Sex Factors; Triglycerides; United States