Aims: We aimed to prospectively analyze the association of serum surrogate markers of cholesterol homeostasis with future cardiovascular events in a population admitted for coronary angiography.
Methods: Markers of cholesterol synthesis were quantified by gas chromatography-mass spectromety in 981 subjects. For the present analysis we excluded patients who were on cholesterol lowering medications, which may interfere with plasma levels of markers of cholesterol homeostasis and their oxides. A total of 377 subjects were included in the final analysis. Patients were followed for occurrence of acute myocardial infarctions, ischemic stroke, and cardiovascular death.
Results: During a mean follow-up period of 4.9+/-1.7 years 44 patients suffered a cardiovascular event. We used the COX-proportional hazard model, adjusted for the ACC/AHA risk score, to analyze the association of serum surrogate markers of cholesterol homeostasis with future cardiovascular death.
Higher levels of lathosterol decreased the risk of an event (Odds-ratio: 0.016; 95%Confidence interval: 0.001 - 0.413). Cholesterol absorption markers - cholestanol, sitosterol and campesterol - (campesterol: OR: 1.205; 95%CI: 0.227 - 6.392; sitosterol: OR: 1.508; 95%CI: 0.184 - 13.869 and cholestanol: OR: 5.532; 95%CI: 0.343 - 89.319) could not be evaluated to have an additional benefit to the ACC/AHA risk score in estimating the risk of future cardiovascular death.
Conclusions: Marker levels of cholesterol homeostasis are correlated with cardiovascular death and potentially also with acute myocardial infarction and ischemic stroke. A detailed analysis of cholesterol homeostasis markers may allow to better predict future cardiovascular events and help to identify patients at higher cardiovascular risk.
Figure 1: Survival estimates for patients admitted for coronary angiography.
Survival estimates with lathosterol < 0.14 mg/dl were significantly lower than in patients with higher levels.