Fatty acids, antioxidants, and coronary heart disease from an epidemiological perspective

Oxidized low density lipoproteins (LDL) play a major role in the development of atherosclerosis. Saturated fatty acids, especially fatty acids with 12-16 carbon atoms, are the most important determinants of the LDL cholesterol level. The LDL lipoprotein fraction can be oxidized by, e.g., smoking. Oxidative damage of LDL lipoproteins can be prevented by nutritive, e.g., vitamin E, and nonnutritive antioxidants, e.g., flavonoids. It can therefore be hypothesized that fatty acids and antioxidants are important determinants of coronary heart disease (CHD). There is a large body of evidence from prospective studies that LDL cholesterol-lowering is associated with a lower CHD risk. The evidence for a protective effect of antioxidants on CHD risk is much weaker and is most promising for vitamin E and flavonoids. The Seven Countries Study showed that at the population level saturated fat, cigarette smoking, and flavonoids are important determinants of long-term CHD mortality. These results suggest that a diet low in saturated fat and rich in antioxidants in combination with no smoking is associated with low CHD risk.