• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of bmjBMJ helping doctors make better decisionsSearch bmj.comLatest content

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

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Robertson TL, Kato H, Rhoads GG, Kagan A, Marmot M, Syme SL, Gordon T, Worth RM, Belsky JL, Dock DS, et al. 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. [PubMed]
  • Hegsted DM, McGandy RB, Myers ML, Stare FJ. Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr. 1965 Nov;17(5):281–295. [PubMed]
  • Stamler J, Wentworth D, Neaton JD. 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]
  • Rimm EB, Giovannucci EL, Willett WC, Colditz GA, Ascherio A, Rosner B, Stampfer MJ. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet. 1991 Aug 24;338(8765):464–468. [PubMed]
  • Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC. 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. [PubMed]
  • Hunter DJ, Rimm EB, Sacks FM, Stampfer MJ, Colditz GA, Litin LB, Willett WC. 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. [PubMed]
  • Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med. 1993 May 20;328(20):1450–1456. [PubMed]
  • Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. 1986 Jul;124(1):17–27. [PubMed]
  • Cupples LA, D'Agostino RB, Anderson K, Kannel WB. Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study. Stat Med. 1988 Jan-Feb;7(1-2):205–222. [PubMed]
  • Rosner B, Spiegelman D, Willett WC. 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. [PubMed]
  • Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC. Validity of self-reported waist and hip circumferences in men and women. Epidemiology. 1990 Nov;1(6):466–473. [PubMed]
  • Giovannucci E, Colditz G, Stampfer MJ, Rimm EB, Litin L, Sampson L, Willett WC. The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol. 1991 Apr 15;133(8):810–817. [PubMed]
  • Chasan-Taber S, Rimm EB, Stampfer MJ, Spiegelman D, Colditz GA, Giovannucci E, Ascherio A, Willett WC. Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals. Epidemiology. 1996 Jan;7(1):81–86. [PubMed]
  • McGee DL, Reed DM, 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. [PubMed]
  • Posner BM, Cobb JL, Belanger AJ, Cupples LA, D'Agostino RB, 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]
  • Goldbourt U, Yaari S, Medalie JH. 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. [PubMed]
  • Morris JN, Marr JW, Clayton DG. Diet and heart: a postscript. Br Med J. 1977 Nov 19;2(6098):1307–1314. [PMC free article] [PubMed]
  • Shekelle RB, Shryock AM, Paul O, Lepper M, Stamler J, Liu S, Raynor WJ., 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. [PubMed]
  • Garcia-Palmieri MR, 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. [PubMed]
  • Gordon T, Kagan A, Garcia-Palmieri M, Kannel WB, Zukel WJ, 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. [PubMed]
  • 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. [PubMed]
  • Fehily AM, Yarnell JW, Sweetnam PM, Elwood PC. Diet and incident ischaemic heart disease: the Caerphilly Study. Br J Nutr. 1993 Mar;69(2):303–314. [PubMed]
  • Gordon DJ, Rifkind BM. High-density lipoprotein--the clinical implications of recent studies. N Engl J Med. 1989 Nov 9;321(19):1311–1316. [PubMed]
  • Stampfer MJ, Sacks FM, Salvini S, Willett WC, Hennekens CH. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med. 1991 Aug 8;325(6):373–381. [PubMed]
  • 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]
  • Khaw KT, 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. [PubMed]
  • Dolecek TA. 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. [PubMed]
  • Kromhout D, Bosschieter EB, 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. [PubMed]
  • Rogers MC. Sir John Scott Burdon-Sanderson (1828-1905): a pioneer in electrophysiology. Circulation. 1969 Jul;40(1):1–2. [PubMed]
  • Turpeinen O, Karvonen MJ, 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. [PubMed]
  • 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. [PubMed]
  • Frantz ID, Jr, Dawson EA, Ashman PL, Gatewood LC, Bartsch GE, Kuba K, Brewer ER. Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis. 1989 Jan-Feb;9(1):129–135. [PubMed]
  • OWREN PA. CORONARY THROMBOSIS: ITS MECHANISM AND POSSIBLE PREVENTION BY LINOLENIC ACID. Ann Intern Med. 1965 Aug;63:167–184. [PubMed]
  • Dayton S, Hashimoto S, Dixon W, Pearce ML. 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]
  • de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, 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. [PubMed]
  • Singh RB, Rastogi SS, Verma R, Laxmi B, Singh R, Ghosh S, Niaz MA. 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. [PMC free article] [PubMed]
  • Sandker GW, Kromhout D, Aravanis C, Bloemberg BP, Mensink RP, Karalias N, Katan MB. 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]
  • 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. [PubMed]
  • Ascherio A, Rimm EB, Stampfer MJ, Giovannucci EL, Willett WC. 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. [PubMed]
  • Willett WC, Ascherio A. Trans fatty acids: are the effects only marginal? Am J Public Health. 1994 May;84(5):722–724. [PMC free article] [PubMed]
  • Willett WC, Stampfer MJ, Manson JE, Colditz GA, Speizer FE, Rosner BA, Sampson LA, Hennekens CH. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet. 1993 Mar 6;341(8845):581–585. [PubMed]
  • Roberts TL, Wood DA, Riemersma RA, Gallagher PJ, Lampe FC. trans isomers of oleic and linoleic acids in adipose tissue and sudden cardiac death. Lancet. 1995 Feb 4;345(8945):278–282. [PubMed]
  • Aro A, Kardinaal AF, Salminen I, Kark JD, Riemersma RA, Delgado-Rodriguez M, Gomez-Aracena J, Huttunen JK, Kohlmeier L, Martin BC, et al. 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. [PubMed]

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

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • Compound
    Compound
    PubChem Compound links
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles
  • Substance
    Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...