Introduction: Worldwide, diabetes is on the rise. Tight glucose control in randomized control trials has not shown significant improvement in cardiovascular outcomes. It is true that hyperglycemia causes a metabolic syndrome and low-density lipoprotein-cholesterol increases, but atheromatous coronary artery disease (CAD) and cerebrovascular disease are not completely curbed by marked reduction of hyperglycemia. It is necessary, therefore, to search for other culprits that cause atheroma. High blood sitosterol causes atheromatous CAD and fatal myocardial infarction in young adults with sitosterolemia, in which mutations in either ABCG5 or G8 proteins cause intestinal hyperabsorption of sitosterol and elevated levels. A milder intestinal genetic defect [ABCG5/G8] is present in diabetics. This fact is unknown to endocrinologists, doctors in the field, researchers, and the public. Diabetics consume much vegetable foods that contain sitosterol. The aim of this study is simply to determine if fasting blood sitosterol is elevated in diabetics, particularly in those with CAD. Materials and methods: Estimation for sitosterol was performed at the Mayo Medical Laboratories for 40 patients with type II diabetes and 17 control subjects. Results: Sitosterol was elevated in 45% of diabetics, and normal in 100% control subjects; 78.26% of diabetic subjects with CAD showed elevated fasting blood sitosterol levels, 5.1 to 9.5 mg/L (normal range 0—4.9 mg/L). Conclusion: This novel but preliminary study shows that 12 to 14 hours fasting blood sitosterol levels are elevated in patients with diabetes particularly in diabetics with CAD. The objective was achieved. Most diabetics have elevated blood sitosterol and require treatment as is done for familial homozygous sitosterolemia.
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