title: Dietary fat and cholesterol and the risk of cardiovascular disease among women with type 2 diabetes.
abstract: BACKGROUND
  Nutritional therapy is a cornerstone of diabetes management, but no epidemiologic studies have investigated the relation between specific dietary fatty acids and cholesterol and cardiovascular disease (CVD) risk among diabetic patients.
  
  
  OBJECTIVE
  This study assessed the relation between specific dietary fatty acids and cholesterol and CVD risk among women with type 2 diabetes.
  
  
  METHODS
  Among 5672 women with type 2 diabetes from the Nurses' Health Study, diet was assessed prospectively and updated periodically. Relative risks of CVD were estimated from Cox proportional hazards analysis after adjustment for potential confounders.
  
  
  RESULTS
  Between 1980 and 1998, we identified 619 new cases of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and stroke). The relative risk (RR) of CVD for an increase of 200 mg cholesterol/1000 kcal was 1.37 (95% CI: 1.12, 1.68; P = 0.003). Each 5% of energy intake from saturated fat, as compared with equivalent energy from carbohydrates, was associated with a 29% greater risk of CVD (RR: 1.29; 95% CI: 1.02, 1.63; P = 0.04). The ratio of polyunsaturated to saturated fat (P:S) was inversely associated with the risk of fatal CVD. We estimated that replacement of 5% of energy from saturated fat with equivalent energy from carbohydrates or monounsaturated fat was associated with a 22% or 37% lower risk of CVD, respectively.
  
  
  CONCLUSIONS
  A higher intake of cholesterol and saturated fat and a low P:S were related to increased CVD risk among women with type 2 diabetes. Among diabetic persons, replacement of saturated fat with monounsaturated fat may be more effective in lowering CVD risk than is replacement with carbohydrates.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, the Channing Laboratory, Boston, USA. mtanasescu@tourou.edu
authors.forename: Mihaela
authors.initials: M
authors.lastname: Tanasescu
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Cho
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D002791:Cholesterol, Dietary / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D004034:Diet Surveys; D004041:Dietary Fats / Q000008:administration & dosage* / Q000009:adverse effects; D005227:Fatty Acids / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D002791:Cholesterol, Dietary; D004041:Dietary Fats; D005227:Fatty Acids