Relationships between nutrient intake and progression/regression of coronary atherosclerosis as assessed by serial...

To elucidate the direction and magnitude of effects of nutrition on coronary artery disease (CAD), the relation between nutrient intake and angiographic changes were examined in the course of a controlled dietary trial. Ninety men with symptomatic CAD and serum cholesterol greater than 232 mg/dL were entered into a randomized controlled trial of a lipid-lowering diet, or of diet plus cholestyramine, compared with usual cardiac care. Of those in the first and second groups, 50 patients completed the trial and are the subject of this report. Quantitative coronary angiography was performed at baseline and at 39 months. From repeated dietary assessment during the trial, mean nutrient intakes were computed, and their relationships with change of coronary artery narrowing were analyzed. Progression of coronary disease was directly, strongly and independently associated with intake of saturated fatty acids of chain length 14-18. This was not fully explained by the effects of saturated fat in raising serum cholesterol; after adjustment for low density lipoprotein cholesterol level, stearic acid (C18:0) intake remained independently predictive of progression. No 'protective' effect of linoleic, linolenic or eicosapentaenoic acid was demonstrable. Intake of trans fatty acids was directly related to progression. Together with the favourable treatment effects on angiographic appearance and clinical end-points, these findings provide further support for a causal role of saturated fats in CAD; restriction of foods containing such fats should be emphasized as part of regimens aimed to reduce progression of coronary atherosclerosis.