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Plasma plant sterol levels: another coronary heart disease risk factor?

The disorder Phytoterolemia is characterized by ≈50-fold elevations in plasma plant sterol levels as well as tendon xanthomas and premature coronary heart disease.1 On pathological examination the xanthomas and arteries of these patients contain plant sterols.2 This has raised questions of whether plant sterols are proatherogenic and whether the “normal” variation of plasma plant sterol levels in the general population is a risk factor for coronary heart disease. The article by Wilund et al in the December 2004 issue of Arteriosclerosis, Thrombosis, and Vascular Biology attempts to answer both questions through a mouse atherosclerosis study and an epidemiological study.3

See December 2004, page 2326 

Phytosterolemia is an autosomal recessive disease, which results from mutations in one or both of two adjacent genes, ABCG5 and ABCG8 .4,5 These genes encode hemi transporters that regulate plasma plant sterol levels by limiting intestinal plant sterol absorption and promoting biliary plant sterol excretion. It is not entirely clear that the elevated plant sterols in Phytosterolemics account for their premature coronary heart disease, because some patients also have very high plasma cholesterol levels in early childhood and most adults with the disorder have moderately elevated plasma cholesterol levels. Therefore, it could be the associated hypercholesterolemia, rather than the elevated plasma plant sterol levels, that is responsible for the premature coronary heart disease.

Plasma plant sterols cannot be synthesized endogenously and are completely derived from the diet. In Western populations, the major plasma plant sterols are campesterol (≈0.33 mg/dL) and sitosterol (≈0.25 mg/dL), with all others, including stigmasterol and brassicasterol, present at much lower concentrations. In the …