title: Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease.
abstract: BACKGROUND
  Dietary fat quality and fat replacement are more important for cardiovascular disease (CVD) prevention than is total dietary fat intake.
  
  
  OBJECTIVE
  The aim was to evaluate the association between total fat intake and fat subtypes with the risk of CVD (myocardial infarction, stroke, or death from cardiovascular causes) and cardiovascular and all-cause death. We also examined the hypothetical effect of the isocaloric substitution of one macronutrient for another.
  
  
  METHODS
  We prospectively studied 7038 participants at high CVD risk from the PREvención con DIeta MEDiterránea (PREDIMED) study. The trial was conducted from 2003 to 2010, but the present analysis was based on an expanded follow-up until 2012. At baseline and yearly thereafter, total and specific fat subtypes were repeatedly measured by using validated food-frequency questionnaires. Time-dependent Cox proportional hazards models were used.
  
  
  RESULTS
  After 6 y of follow-up, we documented 336 CVD cases and 414 total deaths. HRs (95% CIs) for CVD for those in the highest quintile of total fat, monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA) intake compared with those in the lowest quintile were 0.58 (0.39, 0.86), 0.50 (0.31, 0.81), and 0.68 (0.48, 0.96), respectively. In the comparison between extreme quintiles, higher saturated fatty acid (SFA) and trans-fat intakes were associated with 81% (HR: 1.81; 95% CI: 1.05, 3.13) and 67% (HR: 1.67; 95% CI: 1.09, 2.57) higher risk of CVD. Inverse associations with all-cause death were also observed for PUFA and MUFA intakes. Isocaloric replacements of SFAs with MUFAs and PUFAs or trans fat with MUFAs were associated with a lower risk of CVD. SFAs from pastries and processed foods were associated with a higher risk of CVD.
  
  
  CONCLUSIONS
  Intakes of MUFAs and PUFAs were associated with a lower risk of CVD and death, whereas SFA and trans-fat intakes were associated with a higher risk of CVD. The replacement of SFAs with MUFAs and PUFAs or of trans fat with MUFAs was inversely associated with CVD. This trial was registered at www.controlled-trials.com as ISRCTN 35739639.
authors.affiliation: Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain;
authors.forename: Marta
authors.identifier: http://orcid.org/0000-0001-8525-1404
authors.initials: M
authors.lastname: Guasch-Ferré
authors.affiliation: Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain;
authors.forename: Nancy
authors.initials: N
authors.lastname: Babio
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra IDISNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain;
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martínez-González
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain;
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Lipid Clinic, Endocrinology and Nutrition Service and.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain;
authors.forename: Sandra
authors.initials: S
authors.lastname: Martín-Peláez
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Internal Medicine, August Pi i Sunyer Institute of Biomedical Research (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain;
authors.forename: Ramon
authors.initials: R
authors.lastname: Estruch
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Cardiology, University Hospital Araba, Vitoria, Spain;
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine, University of Malaga, Malaga, Spain;
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Gracia
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Palma Institut of Health Research (IdISPa), Palma de Mallorca, Spain;
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Family Medicine, Primary Care Division of Seville, San Pablo Health Center, Seville, Spain; and.
authors.forename: José M
authors.initials: JM
authors.lastname: Santos-Lozano
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
authors.forename: Lluís
authors.initials: L
authors.lastname: Serra-Majem
authors.affiliation: Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain;
authors.forename: Mònica
authors.initials: M
authors.lastname: Bulló
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra IDISNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain;
authors.forename: Estefanía
authors.initials: E
authors.lastname: Toledo
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain;
authors.forename: Rocío
authors.initials: R
authors.lastname: Barragán
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain;
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fitó
authors.affiliation: Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Navarra IDISNA (Instituto de Investigación Sanitaria de Navarra), Pamplona, Spain;
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gea
authors.affiliation: Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; jordi.salas@urv.cat.
authors.forename: Jordi
authors.identifier: http://orcid.org/0000-0003-2700-7459
authors.initials: J
authors.lastname: Salas-Salvadó
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D038441:Diet, Mediterranean; D004041:Dietary Fats / Q000009:adverse effects; D004042:Dietary Fats, Unsaturated / Q000627:therapeutic use; D058620:Elder Nutritional Physiological Phenomena; D057140:Fast Foods / Q000009:adverse effects; D005231:Fatty Acids, Unsaturated / Q000627:therapeutic use; D005500:Follow-Up Studies; D057141:Food, Preserved / Q000009:adverse effects; D015994:Incidence; D009026:Mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D044242:Trans Fatty Acids / Q000009:adverse effects
chemical_list: D004041:Dietary Fats; D004042:Dietary Fats, Unsaturated; D005231:Fatty Acids, Unsaturated; D044242:Trans Fatty Acids
keywords: PREDIMED study; all-cause death; cardiovascular disease; dietary fat; fat subtypes; saturated fat