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Phytosterolaemia, xanthomatosis and premature atherosclerotic arterial disease: a case with high plant sterol absorption, impaired sterol elimination and low cholesterol synthesis
Author(s) -
MIETTINEN TATU A.
Publication year - 1980
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.1980.tb00320.x
Subject(s) - sterol , cholesterol , cholestyramine , medicine , endocrinology , campesterol , squalene , bile acid , stigmasterol , reverse cholesterol transport , familial hypercholesterolemia , chemistry , biology , biochemistry , lipoprotein , chromatography
. A fourth case is described in which phytosterolaemia, earlier diagnosed as familial hypercholes‐terolaemia, was associated with normocholesterol‐aemia, hypersplenism and premature atherosclerotic arterial disease requiring a three‐vessel coronary bypass at the age of 29 years. During a follow‐up of 5 years 22–26% and 27–30% of serum and bile sterols were plant sterols, respectively. In addition to campes‐terol and β‐sitosterol, stigmasterol and a fourth major plant sterol, tentatively identified as avenasterol, were found in bile, and in free and esterified forms in all serum lipoproteins. Analysis of faecal steroids and measurement of biliary lipid secretion indicated that in addition to enhanced absorption of plant sterols their decreased biliary secretion contributed to the development of phytosterolaemia. Impaired biliary cholesterol secretion was compensated for by a markedly reduced cholesterol but normal bile acid synthesis and resulted in bile undersaturated with respect to cholesterol, in a reduced intestinal cholesterol pool and in a very low faecal excretion of cholesterol as neutral sterols. Cholestyramine brought about a modest increase in cholesterol elimination as bile acids, increased cholesterol synthesis as evidenced by the sterol balance value and the increased cholesterol precursors squalene and methyl sterols in plasma and bile, and reduced the plasma cholesterol by 21% and plant sterols by 16%, but had no effect on the biliary composition of main sterols.