Noncholesterol Sterols and Sitosterolemia in Clinical Practice

[See article vol. 27: 409-417] Since the pioneer study by Miettinen that measured serum or plasma noncholesterol sterols using gas-liquid chromatography in many clinical conditions, it is well accepted that a concentration of the cholesterol precursor sterol lathosterol has been used as a surrogate marker of endogenous cholesterol synthesis; the plant sterols such as campesterol and sitosterol are used as markers of cholesterol absorption. HMG-CoA reductase inhibitors (statins) decrease lathosterol and increase campesterol and sitosterol; conversely, a cholesterol absorption inhibitor (ezetimibe) decreases campesterol and sitosterol and increases lathosterol. Some large prospective trials and genome-wide association studies showed that high plasma levels of plant sterols are associated with increased risk of cardiovascular diseases, while others have reported no such association and even an inverse relationship.