Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Saar, Germany.
Chem Phys Lipids. 2011 Sep;164(6):451-6. doi: 10.1016/j.chemphyslip.2011.03.008. Epub 2011 Apr 8.
Hypercholesterolemia is a major risk factor for cardiovascular disease (CVD), and diabetes mellitus and statin treatment affect cholesterol metabolism. The aim of the present study was to evaluate markers of cholesterol metabolism and determine their relationship with CVD in patients without diabetes mellitus who were not receiving statin treatment.
In addition to conventional CVD risk factors, plasma levels of campesterol and sitosterol (indicators of cholesterol absorption) and lathosterol (an indicator of cholesterol synthesis) were determined in 835 consecutive patients referred for coronary angiography. Coronary artery disease was evaluated by coronary angiograms, carotid atherosclerosis and peripheral vascular disease were assessed by Doppler ultrasound, and cerebrovascular accidents and transient ischemic attacks were identified by medical history.
After excluding patients with known diabetes mellitus and those receiving statin treatment, 177 patients were included in the analysis. Compared to patients without CVDs (n=111), patients with concomitant CVDs (n=66) had a reduced lathosterol-to-cholesterol ratio (1.25±0.61 vs. 1.38±0.63, P<0.05) and an increased campesterol-to-cholesterol ratio (1.81±1.04 vs. 1.50±0.69, P<0.05), indicating that enhanced absorption and reduced synthesis of cholesterol is associated with CVD development. Logistic regression analysis including all established cardiovascular risk factors (age, sex, total cholesterol, arterial hypertension, body mass index and smoking) revealed that campesterol and the campesterol-to-cholesterol ratio were significant predictors of concomitant CVD in this patient population.
In patients without diabetes mellitus, markers of enhanced cholesterol absorption were a strong predictor for concomitant CVD.
高胆固醇血症是心血管疾病（CVD）的一个主要危险因素，糖尿病和他汀类药物治疗会影响胆固醇代谢。本研究旨在评估胆固醇代谢标志物，并确定它们与未接受他汀类药物治疗的无糖尿病患者的 CVD 之间的关系。
除了常规 CVD 危险因素外，还在 835 例连续接受冠状动脉造影检查的患者中测定了血浆菜籽固醇和谷固醇（胆固醇吸收指标）和羊毛固醇（胆固醇合成指标）的水平。通过冠状动脉造影评估冠状动脉疾病，通过多普勒超声评估颈动脉粥样硬化和外周血管疾病，通过病史确定脑血管意外和短暂性脑缺血发作。
排除已知糖尿病和接受他汀类药物治疗的患者后，共有 177 例患者纳入分析。与无 CVD 患者（n=111）相比，同时患有 CVD 的患者（n=66）的羊毛固醇/胆固醇比值降低（1.25±0.61 对 1.38±0.63，P<0.05），而菜籽固醇/胆固醇比值升高（1.81±1.04 对 1.50±0.69，P<0.05），表明胆固醇吸收增强和合成减少与 CVD 发展有关。包括所有已确定心血管危险因素（年龄、性别、总胆固醇、动脉高血压、体重指数和吸烟）的 logistic 回归分析显示，菜籽固醇和菜籽固醇/胆固醇比值是该患者人群中同时发生 CVD 的重要预测指标。
在无糖尿病的患者中，增强的胆固醇吸收标志物是同时发生 CVD 的强有力预测指标。
