Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies.
BACKGROUND
Saturated fatty acid (SFA) intake increases plasma LDL-cholesterol concentrations; therefore, intake should be reduced to prevent coronary heart disease (CHD). Lower habitual intakes of SFAs, however, require substitution of other macronutrients to maintain energy balance.


OBJECTIVE
We investigated associations between energy intake from monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and carbohydrates and risk of CHD while assessing the potential effect-modifying role of sex and age. Using substitution models, our aim was to clarify whether energy from unsaturated fatty acids or carbohydrates should replace energy from SFAs to prevent CHD.


METHODS
This was a follow-up study in which data from 11 American and European cohort studies were pooled. The outcome measure was incident CHD.


RESULTS
During 4-10 y of follow-up, 5249 coronary events and 2155 coronary deaths occurred among 344,696 persons. For a 5% lower energy intake from SFAs and a concomitant higher energy intake from PUFAs, there was a significant inverse association between PUFAs and risk of coronary events (hazard ratio: 0.87; 95% CI: 0.77, 0.97); the hazard ratio for coronary deaths was 0.74 (95% CI: 0.61, 0.89). For a 5% lower energy intake from SFAs and a concomitant higher energy intake from carbohydrates, there was a modest significant direct association between carbohydrates and coronary events (hazard ratio: 1.07; 95% CI: 1.01, 1.14); the hazard ratio for coronary deaths was 0.96 (95% CI: 0.82, 1.13). MUFA intake was not associated with CHD. No effect modification by sex or age was found.


CONCLUSIONS
The associations suggest that replacing SFAs with PUFAs rather than MUFAs or carbohydrates prevents CHD over a wide range of intakes.
Jakobsen
Marianne U
MU
Research Unit for Dietary Studies at the Institute of Preventive Medicine, Copenhagen University Hospital, Centre for Health and Society, Copenhagen, Denmark.
O'Reilly
Eilis J
EJ
Heitmann
Berit L
BL
Pereira
Mark A
MA
Bälter
Katarina
K
Fraser
Gary E
GE
Goldbourt
Uri
U
Hallmans
Göran
G
Knekt
Paul
P
Liu
Simin
S
Pietinen
Pirjo
P
Spiegelman
Donna
D
Stevens
June
J
Virtamo
Jarmo
J
Willett
Walter C
WC
Ascherio
Alberto
A
D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D004040:Dietary Carbohydrates; D004041:Dietary Fats / Q000009:adverse effects* / Q000145:classification; D005060:Europe / Q000453:epidemiology; D005227:Fatty Acids / Q000009:adverse effects; D005229:Fatty Acids, Monounsaturated / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
D008078:Cholesterol, LDL; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D005227:Fatty Acids; D005229:Fatty Acids, Monounsaturated