Basal plasma concentrations of plant sterols can predict LDL-C response to sitosterol in patients with familial hypercholesterolemia

Abstract

Background: Familial hypercholesterolemia (FH) is associated with a high risk of coronary heart disease. Pharmacological treatment and diet are both essential for the management of FH. Foods rich in plant sterols (PS) may play an important role in the treatment of patients with these disorders. Objective: To test the effect of the intake of PS on low-density lipoprotein (LDL) concentration, endothelial function (EF) and LDL particle size in 30 patients with FH. Design: Randomized and crossover dietary intervention study. Setting: Tertiary outpatient care. Subjects: Thirty-eight were recruited, but only 30 were subjected to four low-fat dietary intervention periods, each of 4 weeks. Methods: Each intervention had a different content of cholesterol (o150 or 300 mg/day) and sitosterol (o1 or 2 g/day). Lipid response, EF and LDL particle size were analysed after the intervention. Results: Plasma sitosterol/cholesterol ratio was higher during both plant sterol-rich periods than during the low plant sterols periods. Basal sitosterol concentrations predicted the LDL-cholesterol response during the intake of plant sterol-enriched diets. The change in LDL-cholesterol was significantly greater in subjects in the upper and intermediate tertiles of basal plasma sitosterol concentrations (À2178 mg/dl, P ¼ 0.03; À1977 mg/dl, P ¼ 0.04, respectively) than in subjects in the lower tertile (875 mg/dl) when they changed from a low cholesterol diet to a low cholesterol plus plant sterol diet. Conclusion: Our study demonstrates that basal sitosterol values can predict hypolipidemic response in patients with FH.

Baseline plasma plant sterol concentrations do not predict changes in serum lipids, C-reactive protein (CRP) and plasma plant sterols following intake of a plant sterol-enriched food

“…Contrary to findings by Mussner et al (2002), Thuluva et al (2005) and Fuentes et al (2007), the present study results demonstrate that baseline PS are not predictive of changes in TC and LDL-C, following PS supplementation. None of the above-mentioned studies observed associations between baseline plasma PS concentrations and the cholesterol-lowering response.…”

“…In addition, earlier studies have raised the possibility that PS may only show beneficial cholesterol-lowering effects in individuals with HPS concentrations (Mussner et al, 2002;Thuluva et al, 2005;Fuentes et al, 2007). Individuals with higher plasma PS levels may hyperabsorb cholesterol and thus benefit more from an inhibition of intestinal cholesterol absorption.…”

Baseline cholesterol absorption and the response to ezetimibe/simvastatin therapy: a post-hoc analysis of the ENHANCE trial

“…These effects have also been described in FH, although mostly in small-scale studies (11)(12)(13)21) .…”

Microsomal Transfer Protein Inhibitors, New Approach for Treatment of Familial Hypercholesterolemia, Review of the Literature, Original Findings, and Clinical Significance

“…In addition to the cholesterollowering diet, several other dietary interventions have been suggested as some nutritional supplements (pectin, polyphenols, phytosterols). Phytosterols seem to represent the most effective supplementation [27][28][29].…”