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Epidemiology. 2017 Jan;28(1):145-156.

Theoretical Effects of Substituting Butter with Margarine on Risk of Cardiovascular Disease.

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From the aDepartment of Epidemiology, School of Public Health, Brown University, Providence, RI; bCenter for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI; cNational Heart, Lung, and Blood Institute, Bethesda, MD; dDepartment of Medicine, Brown University Alpert School of Medicine, Providence, RI; eUniversity of Tennessee Health Science Center, Memphis, TN; fDivision of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL; gBrigham and Women's Hospital, Harvard Medical School, Boston, MA; hDivision of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; and iDepartment of Family Medicine, Brown University Alpert Medical School, Providence, RI.



Several recent articles have called into question the deleterious effects of high animal fat diets due to mixed results from epidemiologic studies and the lack of clinical trial evidence in meta-analyses of dietary intervention trials. We were interested in examining the theoretical effects of substituting plant-based fats from different types of margarine for animal-based fat from butter on the risk of atherosclerosis-related cardiovascular disease (CVD).


We prospectively studied 71,410 women, aged 50-79 years, and evaluated their risk for clinical myocardial infarction (MI), total coronary heart disease (CHD), ischemic stroke, and atherosclerosis-related CVD with an average of 13.2 years of follow-up. Butter and margarine intakes were obtained at baseline and year 3 by means of a validated food frequency questionnaire. Cox proportional hazards regression using a cumulative average diet method was used to estimate the theoretical effect of substituting 1 teaspoon/day of three types of margarine for the same amount of butter.


Substituting butter or stick margarine with tub margarine was associated with lower risk of MI (HRs = 0.95 and 0.91). Subgroup analyses, which evaluated these substitutions among participants with a single source of spreadable fat, showed stronger associations for MI (HRs = 0.92 and 0.87). Outcomes of total CHD, ischemic stroke, and atherosclerosis-related CVD showed wide confidence intervals but the same trends as the MI results.


This theoretical dietary substitution analysis suggests that substituting butter and stick margarine with tub margarine when spreadable fats are eaten may be associated with reduced risk of myocardial infarction.

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