Institute of Health Sciences/Geriatrics, University of Oulu, and Oulu University Hospital, Unit of General Practice, PO Box 5000, FIN-90014, Oulu, Finland.
Atherosclerosis. 2010 May;210(1):282-7. doi: 10.1016/j.atherosclerosis.2009.11.007. Epub 2009 Nov 13.
To evaluate long-term prognostic effect of serum noncholesterol sterols, including plant sterols, in middle-aged men with high cardiovascular disease (CVD) risk, without statins at baseline.
This was a prospective study of 232 men (mean age 60 years) at high risk of CVD in 1985-1986. Most were hypercholesterolemic, 29 (12%) had a history of CVD or cancer, 6 (3%) had diabetes, and 46 (20%) had metabolic syndrome (MS). Measured noncholesterol sterols (expressed as absolute concentrations or ratios to serum cholesterol to standardize for cholesterol concentrations) included lathosterol and desmosterol (reflect cholesterol synthesis), and plant sterols (campesterol and sitosterol) and cholestanol (reflect cholesterol absorption). Main outcome measure was total mortality.
At baseline, markers of cholesterol synthesis and absorption showed expected inverse associations. During the 22-year follow-up 101 men (43%) died. At baseline, nonsurvivors smoked more, exercised less and had more components of MS (although not filling strict criteria), whereas traditional risk factors of CVD were not significantly different. Of the noncholesterol sterols (either absolute or ratio), only sitosterol was significantly higher in survivors than in nonsurvivors (P=0.02). In multivariable analyses, highest sitosterol-to-cholesterol tertile was associated with significantly lower mortality risk (HR 0.51, 95% CI 0.30-0.87) as compared to lowest tertile. Other associations were nonsignificant, although a "global" index of cholesterol metabolism (desmosterol-to-sitosterol ratio) suggested higher cholesterol synthesis and lower absorption to be associated with higher total and CVD mortality.
Higher serum plant sterol levels in middle-aged men predicted lower long-term mortality risk, possibly reflecting an association between higher synthesis/lower absorption of cholesterol and mortality.
评估血清非胆固醇甾醇（包括植物甾醇）在基线时未服用他汀类药物的中年高心血管疾病（CVD）风险男性中的长期预后作用。
这是一项对 1985 年至 1986 年期间 232 名 CVD 高危男性（平均年龄 60 岁）的前瞻性研究。大多数患者为高胆固醇血症，29 名（12%）有 CVD 或癌症病史，6 名（3%）患有糖尿病，46 名（20%）患有代谢综合征（MS）。测量的非胆固醇甾醇（以绝对浓度或与血清胆固醇的比值表示，以标准化胆固醇浓度）包括羊毛甾醇和去甲胆固醇（反映胆固醇合成）以及植物甾醇（菜油固醇和谷固醇）和胆甾烷醇（反映胆固醇吸收）。主要结局指标为总死亡率。
在基线时，胆固醇合成和吸收的标志物呈预期的反比关系。在 22 年的随访期间，有 101 名男性（43%）死亡。在基线时，非幸存者吸烟更多，运动更少，并且 MS 的成分更多（尽管不符合严格标准），而 CVD 的传统危险因素则没有明显差异。在非胆固醇甾醇（无论是绝对浓度还是比值）中，只有谷固醇在幸存者中明显高于非幸存者（P=0.02）。在多变量分析中，与最低三分位相比，最高的谷固醇/胆固醇三分位与死亡率显著降低相关（HR 0.51，95%CI 0.30-0.87）。其他相关性无统计学意义，尽管胆固醇代谢的“整体”指数（去甲胆固醇/谷固醇比值）表明胆固醇合成较高和吸收较低与总死亡率和 CVD 死亡率较高相关。
中年男性血清植物甾醇水平较高预示着较低的长期死亡率风险，这可能反映了胆固醇合成较高/吸收较低与死亡率之间的关联。
