Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States.
OBJECTIVE
To examine the association between fat intake and the incidence of coronary heart disease in men of middle age and older.


METHODS
Cohort questionnaire study of men followed up for six years from 1986.


METHODS
The health professionals follow up study in the United States.


METHODS
43 757 health professionals aged 40 to 75 years free of diagnosed cardiovascular disease or diabetes in 1986.


METHODS
Incidence of acute myocardial infarction or coronary death.


RESULTS
During follow up 734 coronary events were documented, including 505 non-fatal myocardial infarctions and 229 deaths. After age and several coronary risk factors were controlled for significant positive associations were observed between intake of saturated fat and risk of coronary disease. For men in the top versus the lowest fifth of saturated fat intake (median = 14.8% v 5.7% of energy) the multivariate relative risk for myocardial infarction was 1.22 (95% confidence interval 0.96 to 1.56) and for fatal coronary heart disease was 2.21 (1.38 to 3.54). After adjustment for intake of fibre the risks were 0.96 (0.73 to 1.27) and 1.72 (1.01 to 2.90), respectively. Positive associations between intake of cholesterol and risk of coronary heart disease were similarly attenuated after adjustment for fibre intake. Intake of linolenic acid was inversely associated with risk of myocardial infarction; this association became significant only after adjustment for non-dietary risk factors and was strengthened after adjustment for total fat intake (relative risk 0.41 for a 1% increase in energy, P for trend < 0.01).


CONCLUSIONS
These data do not support the strong association between intake of saturated fat and risk of coronary heart disease suggested by international comparisons. They are compatible, however, with the hypotheses that saturated fat and cholesterol intakes affect the risk of coronary heart disease as predicted by their effects on blood cholesterol concentration. They also support a specific preventive effect of linolenic acid intake.
Ascherio
A
A
Harvard School of Public Health, Boston, MA 02115, USA.
Rimm
E B
EB
Giovannucci
E L
EL
Spiegelman
D
D
Stampfer
M
M
Willett
W C
WC
D000328:Adult; D000368:Aged; D002791:Cholesterol, Dietary / Q000009:adverse effects; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D004041:Dietary Fats / Q000009:adverse effects*; D004043:Dietary Fiber / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D017962:alpha-Linolenic Acid / Q000008:administration & dosage
D002791:Cholesterol, Dietary; D004041:Dietary Fats; D004043:Dietary Fiber; D017962:alpha-Linolenic Acid