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. 2012 May 4;3(3):266–285. doi: 10.3945/an.112.002030

Table 1.

Prospective cohort studies on milk and milk product intake and cardiovascular disease, coronary heart disease, and stroke1

Authors (ref.) Study, country Age, mean or range, y % Men/women Subjects, n/cases, n/follow-up, y Outcome measure Dairy predictor (range, or category or lowest and highest amount) Results Adjustments
Abbott et al. (42) Honolulu Heart Program, Hawaii 60 100/0 3150/229/22 Thromboembolic stroke Milk: 16 oz/d vs. nondrinkers RR: 0.67 (95% CI: 0.45–1.00) Age, dietary K, and Na, alcohol, smoking, activity, blood pressure, glucose, cholesterol, glucose, uric acid, hematocrit
Appleby et al. (29) Oxford Vegetarian Study, UK 34 38/62 10,802/63/12 Fatal CHD Milk: >0.5 pints/d vs. <0.5 pint/d RR: 1.5 (95% CI: 0.81–2.78; P-trend NS) Age, sex, smoking, socioeconomic status
Cheese: <once/wk vs. > 5 times/wk RR: 2.47 (95% CI: 0.97–6.26; P-trend <0.01)
Al-Delaimy et al. (28) Health Professionals Follow-up Study, USA 37 100/0 39,800/1458/12 Total IHD Highest vs. lowest dairy Ca intake Highest vs. lowest Ca intake: RR: 1.03 (95% CI: 0.85–1.26; P -trend NS) Age, time period, energy intake, history of DM, history of hypercholesterolemia, family history of MI, smoking, aspirin, BMI, alcohol, physical activity, vitamin E, trans fat, PUFA:SF ratio, total protein, cereal fiber, folate, (n-3) fatty acids, and α-linolenic acid
Total dairy product intake Total dairy intake: RR: 1.01 (95% CI: 0.83–1.23; P-trend NS)
Bernstein et al. (16) Nurses’ Health Study, USA 58 0/100 84,136/3162/26 Nonfatal and fatal CHD High-fat dairy: 0.33 vs. 3.0 servings/d RR: 1.09 (95% CI: 0.97–1.22; P-trend <0.01) Age, BMI, energy intake, smoking, menopausal status, alcohol, parental history of MI, exercise, vitamin E, aspirin, multivitamin use, time period, cereal fiber, trans fat intake
Low-fat dairy: 0.7 vs. 2.32 servings/d RR: 0.90 (95% CI: 0.80–1.01; P-trend = 0.66)
Bonthuis et al. (27) Australian adults, Australia 25–78 43/57 1529/61/14.4 Fatal CVD Highest vs. lowest tertile for: Age, sex, energy, BMI, alcohol, education, exercise, smoking, dietary supplement, β-carotene, medication use, hypertension, DM, or cardiac disorder and β-adrenergic blocking agent use
Total dairy HR: 0.28 (95% CI: 0.06–1.34; P-trend = 0.20)
Low-fat dairy HR: 1.45 (95% CI: 0.56–3.77; P-trend = 0.69)
Full-fat dairy HR: 0.31 (95% CI: 0.12–0.79; P-trend = 0.04)
Milk HR: 0.60 (95% CI: 0.20–1.81; P-trend = 0.63)
Yogurt HR: 0.65 (95% CI: 0.26–1.58 P-trend = 0.52)
Full-fat cheese HR: 0.64 (95% CI: 0.27–1.49; P-trend = 0.54)
Bostick et al. (31) Iowa Women‘s Health Study, USA 61.5 0/100 34,486/387/8 Fatal CHD Total dairy: highest vs. lowest quartile of intake. RR: 0.94 (95% CI: 0.66–1.35; χ2 for trend 0.22, P-trend = 0.64) Age, BMI, WHR, energy intake, smoking, estrogen, alcohol use, marital status, physical activity, vitamin E, saturated fat intake, education, history of DM
Fat containing dairy: Highest vs. lowest quartile of Intake. RR: 1.14 (95% CI: 0.78–1.66; χ2 for trend = 0.22, P-trend = 0.68)
Elwood et al. (43) Caerphilly cohort, South Wales, UK 52 100/0 2512/493 CHD, 185 stroke/22 Fatal and nonfatal CHD, stroke Milk: >1.0 pints/d HR: 0.71 (95% CI: 0.40–1.26; P-trend = 0.48) Age, BMI, SBP, energy intake, smoking, alcohol use, fat, previous vascular disease
vs. no milk HR: 0.66 (95% CI: 0.24–1.81; P-trend = 0.23)
Goldbohm et al. (15) Netherlands Cohort Study, the Netherlands 62 48/52 120,852/4288/10 Fatal IHD Total milk, per 100 g/d Age, education, BMI, smoking, physical activity, multivitamin use, alcohol use, energy intake, MUFA and PUFA intake, vegetable and fruit intake
Men RR: 1.00 (95% CI: 0.97–1.04; P-trend = 0.806)
Women RR: 1.07 (95% CI: 1.01–1.13; P-trend = 0.050)
Full-fat milk
Men RR: 0.98 (95% CI: 0.93–1.03; P-trend = 0.931)
Women RR: 1.02 (95% CI: 0.92–1.13; P-trend = 0.455)
Low-fat milk
Men RR: 1.05 (95% CI: 1.00–1.10; P-trend = 0.117)
Women RR: 1.04 (95% CI: 0.97–1.12; P-trend = 0.594)
Total cheese, per 10 g/d
Men RR: 1.01 (95% CI: 0.97–1.05; P-trend = 0.639)
Women RR: 1.01 (95% CI: 0.95–1.07; P-trend = 0.832)
Butter
Men RR: 0.95 (95% CI: 0.90–1.01; P-trend = NR)
Women RR: 1.11 (95% CI: 1.01–1.21; P-trend = NR)
Fat from dairy
Men RR: 0.94 (95% CI: 0.89–1.00; P-trend = 0.029)
Women RR: 1.11 (95% CI: 1.01–1.22; P-trend = 0.106)
Fatal stroke Total milk, per 100 g/d
Men RR: 0.98 (95% CI: 0.93, 1.03; P-trend = 0.551)
Women RR: 0.97 (95% CI: 0.91, 1.04; P-trend = 0.557)
Full-fat milk
Men RR: 0.96 (95% CI: 0.89–1.03; P-trend = 0.667)
Women RR: 1.10 (95% CI: 0.99–1.23; P-trend = 0.215)
Low-fat milk
Men RR: 1.05 (95% CI: 0.98–1.13; P-trend = 0.199)
Women RR: 0.96 (95% CI: 0.87–1.05; P-trend = 0.806)
Total cheese, per 10 g/d
Men RR: 1.02 (95% CI: 0.96–1.08; P-trend = 0.403)
Women RR: 0.94 (95% CI: 0.87–1.02; P-trend = 0.169)
Butter
Men RR: 0.97 (95% CI: 0.89–1.05; P-trend = NR)
Women RR: 1.05 (95% CI: 0.92–1.19; P-trend = NS)
Fat from dairy
Men RR: 0.96 (95% CI: 0.88–1.05; P-trend = 0.262)
Women RR: 1.01 (95% CI: 0.89–1.15; P-trend = 0.286)
He et al. (33) Health Professionals Follow-up Study, USA 40–75 100/0 43,732/455 ischemic stroke, 125 hemorrhagic stroke/10 Ischemic stroke, hemorrhagic stroke High-fat dairy, ≥ once/d vs. < once/wk RR: 1.23 (95% CI: 0.74–2.03); P-trend = 0.38) BMI, exercise, hypertension, smoking, aspirin, multivitamin use, alcohol use, potassium, fiber, vitamin E, fruit and vegetable intake, total energy intake, hypercholesterolemia
RR: 1.22 (95% CI: 0.47–3.16); P-trend = 0.53)
Hu et al. (22) Nurses’ Health Study, USA 46.5 0/100 41,254/939/14 Fatal CHD + nonfatal MI High fat dairy: 1 serving/d RR: 1.04 (95% CI: 0.96–1.12; P-trend = 0.33) Age, BMI, energy intake, smoking, menopausal status, alcohol use, parental history of MI, DM, exercise, vitamin E, aspirin, hypertension history, multivitamin use, time period
Low-fat dairy: RR: 0.93 (95% CI: 0.85–1.02; P-trend = 0.11)
Whole milk: almost never vs.1 glass/d RR: 1.67 (95% CI: 1.14–1.90; P-trend < 0.0001)
Skim milk: RR: 0.78 (95% CI: 0.63–0.96; P-trend = 0.09)
Iso et al. (41) Nurses’ Health Study, USA 46 0/100 85,764/347/14 Fatal and nonfatal stroke Total dairy, highest vs. lowest quintile of intake RR: 0.70 (95% CI: 0.51–0.97; P-trend = 0.08) Age, BMI, smoking, menopausal status, alcohol use, hypercholesterolemia, physical activity, vitamin E, aspirin use, hypertension history, multivitamin use, time period, (n-3) intake
Hard cheese: almost never vs. >1 times/d RR: 0.63 (95% CI: 0.40–0.99; P-trend = 0.20)
Milk: almost never vs. >2 times/d+ RR: 0.74 (95% CI: 0.51–1.06; P-trend = 0.44)
Ice cream: almost never vs. >5 times/wk RR: 0.70 (95% CI: 0.42–1.17; P-trend = 0.14)
Cottage cheese: almost never vs. > 5 times/wk. RR: 0.94 (95% CI: 0.60–1.47; P-trend = 0.71)
Kinjo et al. (39) Japanese Prefecture Study, Japan 55 56/44 223,170/11,030/15 Fatal stroke Milk: <1 times/wk vs. >4 times/wk Sex, attained age, alcohol use, smoking, prefecture (= unit of administration or county in China)
All stroke RR: 0.79 (95% CI: 0.75–0.83)
Cerebral hemorrhage RR: 0.74 (95% CI: 0.68–0.80)
Cerebral embolism and thrombosis RR: 0.85 (95% CI: 0.77–0.92)
Larsson et al. (24) Within the Alpha Tocopherol Beta-Carotene Cancer Prevention Study, Finland 57 100/0 26,556/2702/13.6 Fatal and nonfatal stroke: cerebral infarction, intracerebral hemorrhage,2 subarachnoid hemorrhage2 Total dairy: (287 g/d vs. 1296 g/d) RR: 1.14 (95% CI: 0.99–1.32; P-trend = 0.12) Age, education, smoking, BMI, TC, HDL-C, history of DM and heart disease, exercise, total energy, alcohol use, caffeine, sugar, red meat, poultry, fish, fruit, juice, whole grain, refined grain, vegetables, potatoes, supplementation group
Cerebral infarction:
Low-fat milk: (64 g/d vs. 783 g/d), Cerebral infarction: RR: 1.04 (95% CI: 0.92, 1.18; P-trend = 0.60)
Whole milk: (0 g/d vs. 850 g/d), (CI): RR: 1.08 (95% CI: 0.95, 1.23; P-trend = 0.04)
Yogurt: (0 g/d vs. 86 g/d), (CI): RR: 1.08 (95% CI: 0.95, 1.24; P-trend = 0.033)
Cheese: (3 g/d vs. 60 g/d), (CI): RR: 0.88 (95% CI: 0.77–1.01; P-trend = 0.02)
Cream: (2 g/d vs. 51 g/d), (CI): RR: 0.81 (95% CI: 0.72–0.92; P-trend = 0.02)
Ice cream: (0 g/d vs. 11 g/d), (CI): RR: 0.92 (95% CI: 0.81–1.03; P-trend = 0.14)
Butter: (3 g/d vs. 79 g/d), (CI): RR: 1.00 (95% CI: 0.87–1.14; P-trend = 0.99)
Mann et al. (23) Vegetarian and nonvegetarian controls, UK 16–79 38/62 10,802/456/13.3 All-cause and IHD mortality Milk: < 0.5 vs. > 0.5 pints/d Age, sex, smoking, social class
IHD DRR: 150 (95% CI: 81–278; P-trend = NS)
all-cause DRR: 87 (95% CI: 68–113; P-trend = NS)
Cheese: < once/wk vs. ≥ 5 times/wk
IHD DRR: 247 (95% CI: 97–626; P-trend < 0.01)
all-cause DRR: 102 (95% CI: 76–137; P-trend = NS)
Ness et al. (35) Scottish men, UK 48 100/0 5765/2350/25 Fatal CVD Fatal CHD Fatal stroke Milk: none vs. > than 1 pint/d Age, smoking, blood pressure, BMI, cholesterol, forced expiratory volume, social class, angina, education, alcohol use, ECG ischemia, siblings, car user, bronchitis, exercise, deprivation
CVD mortality RR: 0.64 (95% CI: 0.40–1.00; P-trend = 0.05)
CHD mortality RR: 0.68 (95% CI: 0.40–1.13; P-trend = 0.11)
Stroke mortality RR: 0.84 (95% CI: 0.31–2.30; P-trend = 0.58)
Panagiotakos et al. (26) ATTICA Study, Greece 53 50/50 686/30/5 Fatal and nonfatal CVD Low-fat dairy: per one serving increase/wk HR: 0.97 (95% CI: 0.73–1.27; P-trend NS) Age, sex, BMI, smoking, exercise, education, DM, hypercholesterolemia, hypertension
Sauvaget et al. (40) Life Span Study, Japan 56 38/62 31,832/1462/16 Fatal stroke Milk: Never vs. almost daily HR: 0.94 (95% CI: 0.79–1.12; P-trend = 0.232) Age, sex, BMI, smoking, education, radiation dose, history of hypertension or DM, city
Dairy products HR: 0.73 (95% CI: 0.57–0.94; P-trend = 0.024)
Shaper et al. (30) British Regional Heart Study, UK 50 100/0 7735/608/9.5 Fatal and nonfatal IHD Milk: milk intake vs. none RR: 0.88 (95% CI: 0.55–1.40)3 Age, social class, smoking, blood cholesterol, SBP, IHD, DM
Butter: butter intake vs. none RR: 0.87 (95% CI: 0.79–1.06)
Sonestedt et al. (57) Malmo Diet and Cancer cohort, Sweden 44–74 38/62 26,445/2520/12 Fatal and nonfatal CVD Total dairy, portions/day, highest vs. lowest quintile of intake HR: 0.89 (95% CI: 0.78–1.01; P-trend = 0.05) Age, sex, season, method, energy intake, BMI, smoking, alcohol intake, exercise, education, intake of vegetables, fruit, berries, fish, shellfish, meat, coffee, whole grains
Milk, g/day HR: 1.00 (95% CI: 0.88–1.13; P-trend = 0.89)
Low-fat milk, g/day HR: 0.93 (95% CI: 0.82–1.05; P-trend = 0.13)
High-fat milk, g/day HR: 1.03 (95% CI: 0.91–1.17; P-trend = 0.60)
Cheese, g/day HR: 0.94 (95% CI: 0.83–1.06; P-trend = 0.30)
Butter, g/day HR: 0.94 (95% CI: 0.83–1.07; P-trend = 0.16)
Cream, g/day HR: 0.93 (95% CI: 0.83–1.06; P-trend = 0.10)
Trichopoulou et al. (32) Greek population, Greece 42/58 1013/46/4.5 Fatal CVD Total dairy: 150 g increase in dairy products HR: 0.95 (95% CI: 0.68–1.31) Age, sex, BMI, smoking, education, hypertension, DM, weight, height, hip circumference, insulin, food groups
Umesawa et al. (37) Japan Collaborative Cohort, Japan 40–79 39/61 21,068 men, 32,319 women/800/9.6 Dairy calcium: highest vs. lowest quintile of intake Age, sex, BMI, smoking, alcohol use, sodium, potassium, fatty acids, area, menopause, hypercholesterolemia, DM
Total stroke Men RR: 0.53 (95% CI: 0.34–0.81; P-trend < 0.01)
Women RR: 0.57 (95% CI: 0.38–0.86; P-trend = 0.04)
CHD Total Men RR: 0.80 (95% CI: 0.45–1.44; P-trend = 0.63)
Women RR: 1.06 (95% CI: 0.50–2.25); P-trend = 0.40)
CVD Men RR: 0.73 (95% CI: 0.55–0.95); P-trend = 0.06)
Women RR: 0.77 (95% CI: 0.58–1.03); P-trend = 0.01)
Umesawa et al. (38) Japan Public Health Center cohort, Japan 40–59 48/52 41,526/1643/12.9 Dairy calcium: highest vs. lowest quintile of intake Age, sex, BMI, DM, hypercholesterolemia, menopause, smoking, alcohol use, sodium, potassium, (n-3), public health center
Total stroke HR: 0.70 (95% CI: 0.57–0.86); P-trend = 0.01)
CHD HR: 1.09 (0.74–1.61); P-trend = 0.40)
Van der Pols et al. (34) Carnegie (“Boyd Orr”) cohort, UK 73 49/51 4374/378/66–68 Fatal CHD Dairy products: highest vs. lowest quartiles of intake HR: 0.74 (95% CI: 0.45–1.22); P-trend = 0.64) Age, sex, area, energy, fruit, vegetables, eggs, protein, fat, energy
Milk: HR: 0.80 (95% CI:.49–1.31); P-trend = 0.83)
Fatal stroke Dairy products: highest vs. lowest quartiles of intake HR: 0.61 (95% CI: 0.27–1.38); P-trend = 0.16)
Milk: HR: 0.60 (95% CI: 0.28–1.33); P-trend = 0.26)
1

CHD, coronary heart disease; CVD, cardiovascular disease; DM, diabetes mellitus; ECG, electrocardiography; DRR, death rate ratio; HR, hazard ratio; HDL-C, HDL cholesterol; IHD, ischemic heart disease; K, potassium; MI, myocardial infarction; Na, sodium; NR, not reported; SBP, systolic blood pressure; TC, total cholesterol; WHR, waist-to-hip ratio.

2

Results not reported here; see Larsson et al. (24).

3

Reported from Elwood (13).