Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1996 Jul 13;313(7049):84–90. doi: 10.1136/bmj.313.7049.84

Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States.

A Ascherio 1, E B Rimm 1, E L Giovannucci 1, D Spiegelman 1, M Stampfer 1, W C Willett 1
PMCID: PMC2351515  PMID: 8688759

Abstract

OBJECTIVE--To examine the association between fat intake and the incidence of coronary heart disease in men of middle age and older. DESIGN--Cohort questionnaire study of men followed up for six years from 1986. SETTING--The health professionals follow up study in the United States. SUBJECTS--43 757 health professionals aged 40 to 75 years free of diagnosed cardiovascular disease or diabetes in 1986. MAIN OUTCOME MEASURE--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.

Full text

PDF
84

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aro A., Kardinaal A. F., Salminen I., Kark J. D., Riemersma R. A., Delgado-Rodriguez M., Gomez-Aracena J., Huttunen J. K., Kohlmeier L., Martin B. C. Adipose tissue isomeric trans fatty acids and risk of myocardial infarction in nine countries: the EURAMIC study. Lancet. 1995 Feb 4;345(8945):273–278. doi: 10.1016/s0140-6736(95)90273-2. [DOI] [PubMed] [Google Scholar]
  2. Ascherio A., Rimm E. B., Stampfer M. J., Giovannucci E. L., Willett W. C. Dietary intake of marine n-3 fatty acids, fish intake, and the risk of coronary disease among men. N Engl J Med. 1995 Apr 13;332(15):977–982. doi: 10.1056/NEJM199504133321501. [DOI] [PubMed] [Google Scholar]
  3. Chasan-Taber S., Rimm E. B., Stampfer M. J., Spiegelman D., Colditz G. A., Giovannucci E., Ascherio A., Willett W. C. Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals. Epidemiology. 1996 Jan;7(1):81–86. doi: 10.1097/00001648-199601000-00014. [DOI] [PubMed] [Google Scholar]
  4. Cupples L. A., D'Agostino R. B., Anderson K., Kannel W. B. Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study. Stat Med. 1988 Jan-Feb;7(1-2):205–222. doi: 10.1002/sim.4780070122. [DOI] [PubMed] [Google Scholar]
  5. Dayton S., Hashimoto S., Dixon W., Pearce M. L. Composition of lipids in human serum and adipose tissue during prolonged feeding of a diet high in unsaturated fat. J Lipid Res. 1966 Jan;7(1):103–111. [PubMed] [Google Scholar]
  6. Dolecek T. A. Epidemiological evidence of relationships between dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial. Proc Soc Exp Biol Med. 1992 Jun;200(2):177–182. doi: 10.3181/00379727-200-43413. [DOI] [PubMed] [Google Scholar]
  7. Fehily A. M., Yarnell J. W., Sweetnam P. M., Elwood P. C. Diet and incident ischaemic heart disease: the Caerphilly Study. Br J Nutr. 1993 Mar;69(2):303–314. doi: 10.1079/bjn19930035. [DOI] [PubMed] [Google Scholar]
  8. Frantz I. D., Jr, Dawson E. A., Ashman P. L., Gatewood L. C., Bartsch G. E., Kuba K., Brewer E. R. Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis. 1989 Jan-Feb;9(1):129–135. doi: 10.1161/01.atv.9.1.129. [DOI] [PubMed] [Google Scholar]
  9. Garcia-Palmieri M. R., Sorlie P., Tillotson J., Costas R., Jr, Cordero E., Rodriguez M. Relationship of dietary intake to subsequent coronary heart disease incidence: The Puerto Rico Heart Health Program. Am J Clin Nutr. 1980 Aug;33(8):1818–1827. doi: 10.1093/ajcn/33.8.1818. [DOI] [PubMed] [Google Scholar]
  10. Giovannucci E., Colditz G., Stampfer M. J., Rimm E. B., Litin L., Sampson L., Willett W. C. The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol. 1991 Apr 15;133(8):810–817. doi: 10.1093/oxfordjournals.aje.a115960. [DOI] [PubMed] [Google Scholar]
  11. Goldbourt U., Yaari S., Medalie J. H. Factors predictive of long-term coronary heart disease mortality among 10,059 male Israeli civil servants and municipal employees. A 23-year mortality follow-up in the Israeli Ischemic Heart Disease Study. Cardiology. 1993;82(2-3):100–121. doi: 10.1159/000175862. [DOI] [PubMed] [Google Scholar]
  12. Gordon D. J., Rifkind B. M. High-density lipoprotein--the clinical implications of recent studies. N Engl J Med. 1989 Nov 9;321(19):1311–1316. doi: 10.1056/NEJM198911093211907. [DOI] [PubMed] [Google Scholar]
  13. Gordon T., Kagan A., Garcia-Palmieri M., Kannel W. B., Zukel W. J., Tillotson J., Sorlie P., Hjortland M. Diet and its relation to coronary heart disease and death in three populations. Circulation. 1981 Mar;63(3):500–515. doi: 10.1161/01.cir.63.3.500. [DOI] [PubMed] [Google Scholar]
  14. Hegsted D. M., McGandy R. B., Myers M. L., Stare F. J. Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr. 1965 Nov;17(5):281–295. doi: 10.1093/ajcn/17.5.281. [DOI] [PubMed] [Google Scholar]
  15. Hjermann I., Velve Byre K., Holme I., Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet. 1981 Dec 12;2(8259):1303–1310. doi: 10.1016/s0140-6736(81)91338-6. [DOI] [PubMed] [Google Scholar]
  16. Hunter D. J., Rimm E. B., Sacks F. M., Stampfer M. J., Colditz G. A., Litin L. B., Willett W. C. Comparison of measures of fatty acid intake by subcutaneous fat aspirate, food frequency questionnaire, and diet records in a free-living population of US men. Am J Epidemiol. 1992 Feb 15;135(4):418–427. doi: 10.1093/oxfordjournals.aje.a116302. [DOI] [PubMed] [Google Scholar]
  17. Khaw K. T., Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study. N Engl J Med. 1987 Jan 29;316(5):235–240. doi: 10.1056/NEJM198701293160502. [DOI] [PubMed] [Google Scholar]
  18. Kromhout D., Bosschieter E. B., de Lezenne Coulander C. Dietary fibre and 10-year mortality from coronary heart disease, cancer, and all causes. The Zutphen study. Lancet. 1982 Sep 4;2(8297):518–522. doi: 10.1016/s0140-6736(82)90600-6. [DOI] [PubMed] [Google Scholar]
  19. Kromhout D., de Lezenne Coulander C. Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men. The Zutphen Study. Am J Epidemiol. 1984 May;119(5):733–741. doi: 10.1093/oxfordjournals.aje.a113794. [DOI] [PubMed] [Google Scholar]
  20. McGee D. L., Reed D. M., Yano K., Kagan A., Tillotson J. Ten-year incidence of coronary heart disease in the Honolulu Heart Program. Relationship to nutrient intake. Am J Epidemiol. 1984 May;119(5):667–676. doi: 10.1093/oxfordjournals.aje.a113788. [DOI] [PubMed] [Google Scholar]
  21. McKeigue P. Diets for secondary prevention of coronary heart disease: can linolenic acid substitute for oily fish? Lancet. 1994 Jun 11;343(8911):1445–1445. doi: 10.1016/s0140-6736(94)92575-5. [DOI] [PubMed] [Google Scholar]
  22. Morris J. N., Marr J. W., Clayton D. G. Diet and heart: a postscript. Br Med J. 1977 Nov 19;2(6098):1307–1314. doi: 10.1136/bmj.2.6098.1307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Multicentre randomised clinical trial of chorion villus sampling and amniocentesis. First report. Canadian Collaborative CVS-Amniocentesis Clinical Trial Group. Lancet. 1989 Jan 7;1(8628):1–6. [PubMed] [Google Scholar]
  24. OWREN P. A. CORONARY THROMBOSIS: ITS MECHANISM AND POSSIBLE PREVENTION BY LINOLENIC ACID. Ann Intern Med. 1965 Aug;63:167–184. doi: 10.7326/0003-4819-63-2-167. [DOI] [PubMed] [Google Scholar]
  25. Posner B. M., Cobb J. L., Belanger A. J., Cupples L. A., D'Agostino R. B., Stokes J., 3rd Dietary lipid predictors of coronary heart disease in men. The Framingham Study. Arch Intern Med. 1991 Jun;151(6):1181–1187. [PubMed] [Google Scholar]
  26. Rimm E. B., Giovannucci E. L., Stampfer M. J., Colditz G. A., Litin L. B., Willett W. C. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. 1992 May 15;135(10):1114–1136. doi: 10.1093/oxfordjournals.aje.a116211. [DOI] [PubMed] [Google Scholar]
  27. Rimm E. B., Giovannucci E. L., Willett W. C., Colditz G. A., Ascherio A., Rosner B., Stampfer M. J. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet. 1991 Aug 24;338(8765):464–468. doi: 10.1016/0140-6736(91)90542-w. [DOI] [PubMed] [Google Scholar]
  28. Rimm E. B., Stampfer M. J., Ascherio A., Giovannucci E., Colditz G. A., Willett W. C. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med. 1993 May 20;328(20):1450–1456. doi: 10.1056/NEJM199305203282004. [DOI] [PubMed] [Google Scholar]
  29. Rimm E. B., Stampfer M. J., Colditz G. A., Chute C. G., Litin L. B., Willett W. C. Validity of self-reported waist and hip circumferences in men and women. Epidemiology. 1990 Nov;1(6):466–473. doi: 10.1097/00001648-199011000-00009. [DOI] [PubMed] [Google Scholar]
  30. Roberts T. L., Wood D. A., Riemersma R. A., Gallagher P. J., Lampe F. C. trans isomers of oleic and linoleic acids in adipose tissue and sudden cardiac death. Lancet. 1995 Feb 4;345(8945):278–282. doi: 10.1016/s0140-6736(95)90274-0. [DOI] [PubMed] [Google Scholar]
  31. Robertson T. L., Kato H., Rhoads G. G., Kagan A., Marmot M., Syme S. L., Gordon T., Worth R. M., Belsky J. L., Dock D. S. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Incidence of myocardial infarction and death from coronary heart disease. Am J Cardiol. 1977 Feb;39(2):239–243. doi: 10.1016/s0002-9149(77)80197-5. [DOI] [PubMed] [Google Scholar]
  32. Rogers M. C. Sir John Scott Burdon-Sanderson (1828-1905): a pioneer in electrophysiology. Circulation. 1969 Jul;40(1):1–2. doi: 10.1161/01.cir.40.1.1. [DOI] [PubMed] [Google Scholar]
  33. Rosner B., Spiegelman D., Willett W. C. Correction of logistic regression relative risk estimates and confidence intervals for measurement error: the case of multiple covariates measured with error. Am J Epidemiol. 1990 Oct;132(4):734–745. doi: 10.1093/oxfordjournals.aje.a115715. [DOI] [PubMed] [Google Scholar]
  34. Sandker G. W., Kromhout D., Aravanis C., Bloemberg B. P., Mensink R. P., Karalias N., Katan M. B. Serum cholesteryl ester fatty acids and their relation with serum lipids in elderly men in Crete and The Netherlands. Eur J Clin Nutr. 1993 Mar;47(3):201–208. [PubMed] [Google Scholar]
  35. Shekelle R. B., Shryock A. M., Paul O., Lepper M., Stamler J., Liu S., Raynor W. J., Jr Diet, serum cholesterol, and death from coronary heart disease. The Western Electric study. N Engl J Med. 1981 Jan 8;304(2):65–70. doi: 10.1056/NEJM198101083040201. [DOI] [PubMed] [Google Scholar]
  36. Singh R. B., Rastogi S. S., Verma R., Laxmi B., Singh R., Ghosh S., Niaz M. A. Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up. BMJ. 1992 Apr 18;304(6833):1015–1019. doi: 10.1136/bmj.304.6833.1015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Stamler J., Wentworth D., Neaton J. D. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 1986 Nov 28;256(20):2823–2828. [PubMed] [Google Scholar]
  38. Stampfer M. J., Sacks F. M., Salvini S., Willett W. C., Hennekens C. H. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med. 1991 Aug 8;325(6):373–381. doi: 10.1056/NEJM199108083250601. [DOI] [PubMed] [Google Scholar]
  39. Turpeinen O., Karvonen M. J., Pekkarinen M., Miettinen M., Elosuo R., Paavilainen E. Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study. Int J Epidemiol. 1979 Jun;8(2):99–118. doi: 10.1093/ije/8.2.99. [DOI] [PubMed] [Google Scholar]
  40. Willett W. C., Ascherio A. Trans fatty acids: are the effects only marginal? Am J Public Health. 1994 May;84(5):722–724. doi: 10.2105/ajph.84.5.722. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Willett W. C., Stampfer M. J., Manson J. E., Colditz G. A., Speizer F. E., Rosner B. A., Sampson L. A., Hennekens C. H. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet. 1993 Mar 6;341(8845):581–585. doi: 10.1016/0140-6736(93)90350-p. [DOI] [PubMed] [Google Scholar]
  42. Willett W., Stampfer M. J. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. 1986 Jul;124(1):17–27. doi: 10.1093/oxfordjournals.aje.a114366. [DOI] [PubMed] [Google Scholar]
  43. de Lorgeril M., Renaud S., Mamelle N., Salen P., Martin J. L., Monjaud I., Guidollet J., Touboul P., Delaye J. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994 Jun 11;343(8911):1454–1459. doi: 10.1016/s0140-6736(94)92580-1. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES