Original Article

European Journal of Clinical Nutrition (2008) 62, 495–501; doi:10.1038/sj.ejcn.1602731; published online 18 April 2007

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

Guarantors: F Fuentes and P Pérez-Jiménez.

Contributors: FF, L-MJ, and P-J contributed to the concept, design, methodology, statistical analysis, and final approval, GA, P-MP, and PJA to patient recruitment, diet intervention, study of endothelial function, and final approval, and MJ, CJ, CM, and RE to analytical determinations, LDL particle size, and determination of plant sterols.

F Fuentes1, J López-Miranda1, A García1, P Pérez-Martínez1, J Moreno1, M Cofan2, J Caballero3, J A Paniagua1, E Ros2 and F Pérez-Jiménez1

  1. 1Lipids and Atherosclerosis Unit, Hospital Universitario Reina Sofía, Ciber Fisiopatología Obesidad y Nutrición Instituto de Salud Carlos III, Córdoba, Spain
  2. 2IDIBAPS. Hospital Clínico, Barcelona, Spain
  3. 3Biochemistry Service, Hospital Universitario Reina Sofía, Córdoba, Spain

Correspondence: Dr F Fuentes Jiménez, Lipids and Atherosclerosis Unit, Internal Medicine Service, Hospital Universitario Reina Sofía, Córdoba, Spain. Avda. Menéndez Pidal, s/n, 14004-Córdoba Spain. E-mail: fjfuentesjimenez@yahoo.es

Received 24 April 2006; Revised 13 February 2007; Accepted 19 February 2007; Published online 18 April 2007.

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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 (<150 or 300 mg/day) and sitosterol (<1 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 (-21plusminus8 mg/dl, P=0.03; -19plusminus7 mg/dl, P=0.04, respectively) than in subjects in the lower tertile (8plusminus5 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.

Keywords:

phytosterols, familial hypercholesterolemia, diet, LDL particle size, endothelial function

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