Plant sterols might be an additional risk factor for coronary heart disease

This study was published in Metabolism 2002 Dec;51(12):1519-21

Study title and authors:
Serum plant sterols as a potential risk factor for coronary heart disease.

Sudhop T, Gottwald BM, von Bergmann K.
Department of Clinical Pharmacology, University of Bonn, Bonn, Germany.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/12489060

The lead author of the study, Dr Thomas Sudhop, notes that in patients with the inherited disease of phytosterolemia, elevated concentrations of plant sterols (eg, campesterol and sitosterol) (think Benecol and Flora proactive) have been implicated as a risk factor for premature atherosclerosis.

This study examined the role of plant sterols in patients (with plant sterol levels in the normal range) admitted for elective artery coronary bypass graft surgery. The study included 53 patients of which 26 reported a family history in their first-degree relatives for coronary heart disease.

The study found:
(a) Patients with a positive family history for coronary heart disease had a significant 31% higher plasma levels of campesterol compared to patients without a family history of coronary heart disease.
(b) Patients with a positive family history for coronary heart disease had a significant 29% higher plasma levels of sitosterol compared to patients without a family history of coronary heart disease.
(c) Patients with a positive family history for coronary heart disease had a significantly higher ratios of sitosterol to cholesterol and campesterol to cholesterol compared to patients without a family history of coronary heart disease.

Dr Sudhop concluded: "These findings support the hypothesis that plant sterols might be an additional risk factor for coronary heart disease".

Sitosterol, a constituent of Benecol and Flora proactive, is associated with an increased occurrence of major coronary events

This study was published in Nutrition, Metabolism and Cardiovascular Diseases 2006 Jan;16(1):13-21

Study title and authors:
Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study.

Assmann G, Cullen P, Erbey J, Ramey DR, Kannenberg F, Schulte H.
Leibniz-Institut für Arterioskleroseforschung an der Universität Münster, Domagkstrasse 3, 48149 Münster, Germany. assmann@uni-muenster.de

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/16399487

Phytosterols such as sitosterol are inserted in high quantities (at 841 times than the average vegetable) in plant sterol based margarines such as Benecol and Flora proactive.

This study was conducted to evaluate if sitosterol levels seen in the general population are associated with the occurrence of coronary events. The ten year study included 159 men who suffered a heart attack or sudden coronary death (major coronary event), who were compared with 318 control subjects.

The study found:
(a) Men with the highest sitosterol levels had a 1.8-fold increase in the risk of a major coronary event compared to men with lower levels.
(b) Among men with a high risk of a major coronary event, high sitosterol concentrations were associated with an additional 3-fold increase in the incidence of coronary events.
(c) Men with a high sitosterol/cholesterol ratio had a 3-fold increase in the incidence of coronary events.

Assmann concluded: "Elevations in sitosterol concentrations and the sitosterol/cholesterol ratio appear to be associated with an increased occurrence of major coronary events in men at high global risk of coronary heart disease".

Plant sterols, found in Benecol and Flora proactive, are associated with an increased risk of coronary artery disease

This study was published in Steroids 2015 Mar 23

Study title and authors:
Increased plant sterol deposition in vascular tissue characterizes patients with severe aortic stenosis and concomitant coronary artery disease.

Luister A, Schött HF, Husche C, Schäfers HJ, Böhm M, Plat J, Gräber S, Lütjohann D, Laufs U, Weingärtner O.
Klinik für Innere Medizin III¸Kardiologie, Angiologie und Internistische Intensivmedizin.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/25814070

Phytosterols are present in very small quantities in fruit and vegetables. The phytosterol content of plant sterol-enriched margarines (Benecol, Flora proactive etc) are higher by an order of magnitude of up to 841 times than the average vegetable (see here). Campesterol and sitosterol are types of phytosterols.

Oxyphytosterols are phytosterols that have gone rancid.

Cholestanol is a derivative of cholesterol.

The aim of the study (of 104 patients) was to evaluate the relationship between phytosterols, oxyphytosterols, lathosterol, cholestanol and cholesterol in patients with severe aortic stenosis (artery blockages), some of whom also had coronary artery disease who were scheduled for elective aortic valve replacement.

The study found:
(a) The ratio of campesterol-to-cholesterol was increased by 26% in plasma of patients with coronary artery disease compared to those without coronary artery disease.
(b) Sitosterol concentrations were increased by 38.8% in the tissues of patients with coronary artery disease compared to those without coronary artery disease.
(c) Campesterol concentrations were increased by 30.4% in the tissues of patients with coronary artery disease compared to those without coronary artery disease.
(d) Oxidized sitosterol-to-cholesterol ratios were up-regulated by 22.7% in the plasma of patients with coronary artery disease compared to those without coronary artery disease.
(e) Oxidized campesterol was increased by 17.1% in the aortic valve cusps (the triangular fold or flap of a heart valve) of patients with coronary artery disease compared to those without coronary artery disease.
(f) Neither cholestanol nor the ratio of cholestanol-to-cholesterol was associated with coronary artery disease.

Luister concluded: "Patients with concomitant coronary artery disease are characterized by increased deposition of plant sterols, but not cholestanol in aortic valve tissue. Moreover, patients with concomitant coronary artery disease were characterized by increased oxyphytosterol concentrations in plasma and aortic valve cusps".

Is it wise to consume margarines high in phytosterols (such as Benecol and Flora proactive) when the study suggests that phytosterols are associated with a higher risk of coronary artery disease?