TY - JOUR
T1 - Intake of phytosterols from natural sources and risk of cardiovascular disease in the European Prospective Investigation into Cancer and Nutrition-the Netherlands (EPIC-NL) population
AU - Ras, Rouyanne T.
AU - Van Der Schouw, Yvonne T.
AU - Trautwein, Elke A.
AU - Sioen, Isabelle
AU - Dalmeijer, Geertje W.
AU - Zock, Peter L.
AU - Beulens, Joline W.J.
PY - 2015/8/11
Y1 - 2015/8/11
N2 - Background: Phytosterols (PSs) are known to lower low-density lipoprotein cholesterol (LDL-C), an established risk factor for cardiovascular disease (CVD). Whether a high intake of PS reduces CVD risk is unknown. This observational study aimed to investigate the associations between intake of naturally occurring PSs, blood lipids and CVD risk. Methods: The study included 35,597 Dutch men and women, participating in the European Prospective Investigation into Cancer and Nutrition-the Netherlands (EPIC-NL) study. At baseline, intakes of naturally occurring PSs were estimated with a validated food frequency questionnaire and non-fasting blood lipids were measured. Occurrence of CVD, coronary heart disease (CHD) and myocardial infarction (MI) was determined through linkage with registries. Results: The average energy-adjusted PS intake at baseline was 296 mg/d (range: 83-966 mg/d). During 12.2 years of follow-up, 3047 CVD cases (8.6%) were documented. After adjustment for confounders, PS intake was not associated with risk of CVD, CHD or MI (p-value trend>0.05); hazard ratios ranged from 0.90-0.99 for CVD, from 0.83-0.90 for CHD and from 0.80-0.95 for MI risk across quintiles of PS intake and were almost all non-significant. Higher PS intake was associated with lower total cholesterol (-0.06 mmol/l per 50 mg/d; p-value=0.038) and lower LDL-C (-0.07 mmol/l; p-value=0.007), particularly among men. In mediation analysis, LDL-C did not materially affect the association between PS intake and CVD risk. Conclusions: In this population with a relatively narrow range of low naturally occurring PS intakes, intake of PS was not associated with reduced CVD risk despite lower LDL-C concentrations in men.
AB - Background: Phytosterols (PSs) are known to lower low-density lipoprotein cholesterol (LDL-C), an established risk factor for cardiovascular disease (CVD). Whether a high intake of PS reduces CVD risk is unknown. This observational study aimed to investigate the associations between intake of naturally occurring PSs, blood lipids and CVD risk. Methods: The study included 35,597 Dutch men and women, participating in the European Prospective Investigation into Cancer and Nutrition-the Netherlands (EPIC-NL) study. At baseline, intakes of naturally occurring PSs were estimated with a validated food frequency questionnaire and non-fasting blood lipids were measured. Occurrence of CVD, coronary heart disease (CHD) and myocardial infarction (MI) was determined through linkage with registries. Results: The average energy-adjusted PS intake at baseline was 296 mg/d (range: 83-966 mg/d). During 12.2 years of follow-up, 3047 CVD cases (8.6%) were documented. After adjustment for confounders, PS intake was not associated with risk of CVD, CHD or MI (p-value trend>0.05); hazard ratios ranged from 0.90-0.99 for CVD, from 0.83-0.90 for CHD and from 0.80-0.95 for MI risk across quintiles of PS intake and were almost all non-significant. Higher PS intake was associated with lower total cholesterol (-0.06 mmol/l per 50 mg/d; p-value=0.038) and lower LDL-C (-0.07 mmol/l; p-value=0.007), particularly among men. In mediation analysis, LDL-C did not materially affect the association between PS intake and CVD risk. Conclusions: In this population with a relatively narrow range of low naturally occurring PS intakes, intake of PS was not associated with reduced CVD risk despite lower LDL-C concentrations in men.
KW - Phytosterols
KW - blood lipids
KW - cardiovascular disease
UR - http://www.scopus.com/inward/record.url?scp=84936948325&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/2047487314554864
DO - https://doi.org/10.1177/2047487314554864
M3 - Article
C2 - 25305273
SN - 2047-4873
VL - 22
SP - 1067
EP - 1075
JO - European journal of preventive cardiology
JF - European journal of preventive cardiology
IS - 8
ER -