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Relationship between dietary intake and coronary heart disease mortality: lipid research clinics prevalence follow-up
K L Esrey1, L Joseph, S A Grover
1Centre For the Analysis of Cost-Effective Care, Montreal General Hospital, Quebec, Canada.
Insights
High fat intake increases coronary heart disease (CHD) mortality risk in adults aged 30-59. Carbohydrate intake showed a protective effect, suggesting diet
Area of Science:
- Cardiovascular epidemiology
- Nutritional science
- Public health
Background:
- The diet-heart hypothesis links dietary fat and cholesterol to coronary heart disease (CHD) risk via serum cholesterol.
- Existing research suggests a correlation between dietary patterns and cardiovascular outcomes.
Purpose of the Study:
- To investigate the association between dietary intake and 12-year CHD mortality.
- To evaluate the diet-heart hypothesis in a North American cohort.
Main Methods:
- Utilized data from the Lipid Research Clinics Prevalence Follow-Up Study (4546 participants).
- Dietary intake assessed via 24-hour recall in individuals aged 30+ initially free of CHD.
- Proportional hazards analyses were employed to assess risk factors for CHD mortality.
Main Results:
- Increased energy intake from total fat, saturated fat, and monounsaturated fat significantly elevated CHD mortality risk in adults aged 30-59.
- Higher carbohydrate energy intake demonstrated a significant protective effect against CHD mortality in the same age group.
- Associations remained significant after adjusting for serum lipids, suggesting lipids may not fully mediate the diet-CHD link. No significant associations were found for those aged 60-79.
Conclusions:
- Dietary fat intake is a significant risk factor for CHD mortality in middle-aged adults.
- Carbohydrate intake may offer protection against CHD mortality.
- The current diet-lipid-heart hypothesis may be an oversimplification; further research is needed to elucidate the complex pathways between diet and coronary disease.
Abstract:
The diet-heart hypothesis proposes that elevated intakes of total fat, saturated fat, and dietary cholesterol raise serum cholesterol, which in turn increases the risk of developing coronary heart disease (CHD). To examine the relationship between dietary intake and 12-year CHD mortality we used data from the Lipid Research Clinics Prevalence Follow-Up Study. Dietary intake was measured at study entry using the 24-hour recall technique among 4546 North American men and women who were at least 30 years old and initially free of CHD. Proportional hazards analyses controlling for total energy intake indicated that increasing percentages of energy intake as total fat (RR 1.04, 95% CI = 1.01-1.08), saturated fat (RR 1.11, CI = 1.04-1.18), and monounsaturated fat (RR 1.08, CI = 1.01-1.16) were significant risk factors for CHD mortality among 30 to 59 year olds. The increasing percentage of energy intake from carbohydrate had a significant protective effect (RR 0.96, CI = 0.94-0.99). The strength of these associations was not diminished after adjustment for specific serum lipids, suggesting that serum lipids did not mediate the effect of diet on CHD mortality. None of the dietary components were significantly associated with CHD mortality among those aged 60-79 years. We conclude that future research must be directed toward better understanding the pathway between dietary intake and coronary disease as the current diet-lipid-heart hypothesis may be overly simplistic.
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