Cholesterol-Lowering Foods and Reduction in Serum Cholesterol Levels—Reply

In Reply: Dr Weingärtner and colleagues raise an issue regarding elevated plasma plant sterol concentrations and increased risk of coronary heart disease (CHD). However, this assessment did not take into consideration important human epidemiological studies that suggest a reduction in CHD risk with increased plasma plant sterol levels. In a large cross-sectional human study of 2542 middle-aged persons, plant sterol levels were not associated with increased CHD risk or family history of CHD.¹ Results of a cohort study with 1242 individuals aged 65 years or older in the Longitudinal Aging Study Amsterdam (LASA) revealed that moderately increased and high concentrations of plasma sitosterol were associated with reduced CHD risk.² The prospective EPIC-Norfolk population study showed no difference in baseline plasma plant sterol concentrations between healthy subjects who developed CHD during the 6-year follow-up compared with those who did not.³ The wide age range and ethnic diversity of these large studies suggest that their findings will be relevant to the general population.