Highlights
- •TFA from partially hydrogenated vegetable oils should be eliminated from the human diet.
- •Cardiovascular risk can be modestly reduced by decreasing SFA and replacing it by a combination of PUFA and MUFA.
- •n-3 seafood PUFA may protect against CVD, though the benefits seem to be not as pronounced as previously believed.
- •Animal product intake (unprocessed red meat, egg, dairy) is not necessarily associated with increased cardiovascular risk.
- •Nut and olive oil intake is associated with reduced cardiovascular risk.
Abstract
Dietary fatty acids play significant roles in the cause and prevention of cardiovascular
disease (CVD). Trans fatty acids from partially hydrogenated vegetable oils have well-established
adverse effects and should be eliminated from the human diet. CVD risk can be modestly
reduced by decreasing saturated fatty acids (SFA) and replacing it by a combination
of polyunsaturated fatty acids (PUFA) and monounsaturated fatty acids (MUFA). Although
the ideal type of unsaturated fat for this replacement is unclear, the benefits of
PUFA appear strongest. Both n-6 and n-3 PUFA are essential and reduce CVD risk. However,
additional research is needed to better define the optimal amounts of both and to
discern the patients and/or general population that would benefit from supplemental
n-3 fatty acid intake. Furthermore, consumption of animal products, per se, is not
necessarily associated with increased CVD risk, whereas nut and olive oil intake is
associated with reduced CVD risk. In conclusion, the total matrix of a food is more
important than just its fatty acid content in predicting the effect of a food on CVD
risk, and a healthy diet should be the cornerstone of CVD prevention.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s?.Heart. 2013; 99: 159-162
- NHLBI fact book, fiscal year 2012. National Heart, Lung, and Blood Institute, Bethesda, MD2013
- Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2071-2094
- Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2197-2223
- European Cardiovascular Disease Statistics 2012. 2012
- Atherosclerosis–an inflammatory disease.N Engl J Med. 1999; 340: 115-126
- A tale of coronary artery disease and myocardial infarction.N Engl J Med. 2012; 366: 54-63
- European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).Eur Heart J. 2012; 33: 1635-1701
- Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.Circulation. 2006; 114: 82-96
- Towards establishing dietary reference intakes for eicosapentaenoic and docosahexaenoic acids.J Nutr. 2009; 139: 804S-819S
- Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence.Lipids. 2010; 45: 893-905
- Thematic review series: the pathogenesis of atherosclerosis. An interpretive history of the cholesterol controversy: part I.J Lipid Res. 2004; 45: 1583-1593
- Epidemiological studies related to coronary heart disease: characteristics of men aged 40-59 in seven countries.Acta Med Scand Suppl. 1966; 460: 1-392
- The diet-heart idea. Outline of a history.Am J Epidemiol. 1988; 127: 220-225
- Dietary fatty acids and cardiovascular disease.Animal. 2013; 7: 163-171
- Dietary fats and coronary heart disease.J Intern Med. 2012; 272: 13-24
- Trends in intake of energy and macronutrients–United States, 1971-2000.MMWR Morb Mortal Wkly Rep. 2004; 53: 80-82
- Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial.J Am Med Assoc. 2006; 295: 655-666
- Low-carbohydrate-diet score and the risk of coronary heart disease in women.N Engl J Med. 2006; 355: 1991-2002
- High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study.J Am Coll Cardiol. 2007; 50: 14-21
- Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index.Am J Clin Nutr. 2010; 91: 1764-1768
- Meta-analysis of dietary glycemic load and glycemic index in relation to risk of coronary heart disease.Am J Cardiol. 2012; 109: 1608-1613
- Associations of glycemic index and load with coronary heart disease events: a systematic review and meta-analysis of prospective cohorts.J Am Heart Assoc. 2012; 1: e000752
- Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: a systematic review with meta-analysis.PLoS One. 2012; 7: e52182
- Serum cholesterol response to changes in diet. IV. Particular saturated fatty acids in the diet.Metabolism. 1965; 14: 12
- Quantitative effects of dietary fat on serum cholesterol in man.Am J Clin Nutr. 1965; 17: 281-295
- Effects of diet on blood lipids in man, particularly cholesterol and lipoproteins.Clin Chem. 1955; 1: 34-52
- Prediction of serum-cholesterol responses of man to changes in fats in the diet.Lancet. 1957; 273: 959-966
- Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).Lancet. 1994; 344: 1383-1389
- Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group.N Engl J Med. 1995; 333: 1301-1307
- Management of low levels of high-density lipoprotein-cholesterol.Circulation. 2013; 128: 72-78
- Lipoproteins, nutrition, and heart disease.Am J Clin Nutr. 2002; 75: 191-212
- Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials.Am J Clin Nutr. 2003; 77: 1146-1155
- Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials.Ann Nutr Metab. 2009; 55: 173-201
- A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease.Arch Intern Med. 2009; 169: 659-669
- Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.Am J Clin Nutr. 2010; 91: 535-546
- Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies.Am J Clin Nutr. 2009; 89: 1425-1432
- Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials.PLoS Med. 2010; 7: e1000252
- Reduced or modified dietary fat for preventing cardiovascular disease.Cochrane Database Syst Rev. 2012; 5: CD002137
- Plasma cholesterol-predictive equations demonstrate that stearic acid is neutral and monounsaturated fatty acids are hypocholesterolemic.Am J Clin Nutr. 1995; 61: 1129-1139
- Cardiovascular disease risk of dietary stearic acid compared with trans, other saturated, and unsaturated fatty acids: a systematic review.Am J Clin Nutr. 2010; 91: 46-63
- Effects of cocoa products/dark chocolate on serum lipids: a meta-analysis.Eur J Clin Nutr. 2011; 65: 879-886
- 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; https://doi.org/10.1016/j.jacc.2013.11.003
- Fatty acids in cardiovascular health and disease: a comprehensive update.J Clin Lipidol. 2012; 6: 216-234
- Trans fatty acids and cardiovascular disease.N Engl J Med. 2006; 354: 1601-1613
- Quantitative effects on cardiovascular risk factors and coronary heart disease risk of replacing partially hydrogenated vegetable oils with other fats and oils.Eur J Clin Nutr. 2009; 63: S22-S33
- The effectiveness of policies for reducing dietary trans fat: a systematic review of the evidence.Bull World Health Organ. 2013; 91: 262H-269H
- US moves to ban trans fats.Brit Med J. 2013; 347: f6749
- Ruminant and industrially produced trans fatty acids: health aspects.Food Nutr Res. 2008; 52
- Effect of animal and industrial trans fatty acids on HDL and LDL cholesterol levels in humans–a quantitative review.PLoS One. 2010; 5: e9434
- Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies.Eur J Clin Nutr. 2011; 65: 773-783
- Dietary n-6 and n-3 polyunsaturated fatty acids: from biochemistry to clinical implications in cardiovascular prevention.Biochem Pharmacol. 2009; 77: 937-946
- Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events.J Am Coll Cardiol. 2011; 58: 2047-2067
- Omega-6 fatty acids and risk for cardiovascular disease: a science advisory from the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention.Circulation. 2009; 119: 902-907
- Dietary fat quality and risk of sudden cardiac death in women.Am J Clin Nutr. 2012; 96: 498-507
- All PUFAs are not created equal: absence of CHD benefit specific to linoleic acid in randomized controlled trials and prospective observational cohorts.World Rev Nutr Diet. 2011; 102: 30-43
- Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis.Brit Med J. 2013; 346
- n-3 fatty acids in cardiovascular disease.N Engl J Med. 2011; 364: 2439-2450
- Omega 3 fatty acids and cardiovascular outcomes: systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2012; 5: 808-818
- Long chain omega-3 fatty acids and cardiovascular disease: a systematic review.Br J Nutr. 2012; 107: S201-S213
- Long-term effect of high dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: a meta-analysis of randomized, double blind, placebo controlled trials.Atheroscler Suppl. 2013; 14: 243-251
- Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis.J Am Med Assoc. 2012; 308: 1024-1033
- Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis.Brit Med J. 2012; 345: e6698
- n–3 fatty acids and cardiovascular outcomes in patients with Dysglycemia.N Engl J Med. 2012; 367: 309-318
- n-3 PUFAs in cardiovascular disease.Int J Cardiol. 2013; 170: S33-S38
- n-3 fatty acids in patients with multiple cardiovascular risk factors.N Engl J Med. 2013; 368: 1800-1808
- Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I.Circulation. 2006; 113: 195-202
- Intake of total omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid and risk of coronary heart disease in the Spanish EPIC cohort study.Nutr Metab Cardiovasc Dis. 2014 Mar; 24 ([Epub 2013 Dec 20]): 321-327https://doi.org/10.1016/j.numecd.2013.08.011
- Fish intake, contaminants, and human health: evaluating the risks and the benefits.J Am Med Assoc. 2006; 296: 1885-1899
- Do omega-3 polyunsaturated fatty acids reduce risk of sudden cardiac death and ventricular arrhythmias? A meta-analysis of randomized trials.Heart Lung J Crit Care. 2013; 42: 251-256
- N-3 polyunsaturated fatty acids to prevent atrial fibrillation: updated systematic review and meta-analysis of randomized controlled trials.J Am Heart Assoc. 2013; 2: e005033
- Fish oil and post-operative atrial fibrillation: a meta-analysis of randomized controlled trials.J Am Coll Cardiol. 2013; 61: 2194-2196
- 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.Circulation. 2012; 126: e354-e471
- Alpha-linolenic acid: is it essential to cardiovascular health?.Curr Atheroscler Rep. 2010; 12: 359-367
- Alpha-Linolenic acid and risk of cardiovascular disease: a systematic review and meta-analysis.Am J Clin Nutr. 2012; 96: 1262-1273
- The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases.Exp Biol Med (Maywood). 2008; 233: 674-688
- The Omega-3 Index: a new risk factor for death from coronary heart disease?.Prev Med. 2004; 39: 212-220
- The omega-3 index: clinical utility for therapeutic intervention.Curr Cardiol Rep. 2010; 12: 503-508
- Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest.J Am Med Assoc. 1995; 274: 1363-1367
- Blood levels of long-chain n-3 fatty acids and the risk of sudden death.N Engl J Med. 2002; 346: 1113-1118
- EPA and DHA in blood cell membranes from acute coronary syndrome patients and controls.Atherosclerosis. 2008; 197: 821-828
- Erythrocyte fatty acid profiles can predict acute non-fatal myocardial infarction.Br J Nutr. 2009; 102: 1355-1361
- Comparison of effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on plasma lipids and lipoproteins in man.J Lipid Res. 1985; 26: 194-202
- Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.J Am Med Assoc. 2005; 294: 2455-2464
- Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states.Am J Clin Nutr. 2007; 86: 1611-1620
- Monounsaturated versus polyunsaturated dietary fat and serum lipids. A meta-analysis.Arterioscler Thromb Vasc Biol. 1995; 15: 1917-1927
- Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies.Brit Med J. 1997; 314: 112-117
- Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors.Lipids. 2011; 46: 209-228
- Effects of monounsaturated fatty acids on cardiovascular risk factors: a systematic review and meta-analysis.Ann Nutr Metab. 2011; 59: 176-186
- Effect of high-carbohydrate or high-cis-monounsaturated fat diets on blood pressure: a meta-analysis of intervention trials.Am J Clin Nutr. 2007; 85: 1251-1256
- Monounsaturated fatty acids and risk of cardiovascular disease: synopsis of the evidence available from systematic reviews and meta-analyses.Nutrients. 2012; 4: 1989-2007
- Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis.Circulation. 2010; 121: 2271-2283
- Red meat consumption and mortality: results from 2 prospective cohort studies.Arch Intern Med. 2012; 172: 555-563
- Meat consumption and mortality – results from the European Prospective Investigation into Cancer and Nutrition.BMC Med. 2013; 11: 63
- Meat intake and cause-specific mortality: a pooled analysis of Asian prospective cohort studies.Am J Clin Nutr. 2013; 98: 1032-1041
- Red meat consumption and risk of stroke: a meta-analysis of prospective studies.Stroke. 2012; 43: 2556-2560
- Red and processed meat consumption and risk of stroke: a meta-analysis of prospective cohort studies.Eur J Clin Nutr. 2013; 67: 91-95
- Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis.Am J Clin Nutr. 2011; 94: 1088-1096
- Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women.J Am Med Assoc Intern Med. 2013; 173: 1328-1335
- Influence of dairy product and milk fat consumption on cardiovascular disease risk: a review of the evidence.Adv Nutr. 2012; 3: 266-285
- The consumption of milk and dairy foods and the incidence of vascular disease and diabetes: an overview of the evidence.Lipids. 2010; 45: 925-939
- Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies.Am J Clin Nutr. 2011; 93: 158-171
- Dairy consumption and incidence of hypertension: a dose-response meta-analysis of prospective cohort studies.Hypertension. 2012; 60: 1131-1137
- A systematic review and meta-analysis of elevated blood pressure and consumption of dairy foods.J Hum Hypertens. 2012; 26: 3-13
- Dairy products consumption and risk of type 2 diabetes: systematic review and dose-response meta-analysis.PLoS One. 2013; 8: e73965
- Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies.Am J Clin Nutr. 2013; 98: 1066-1083
- Diet and risk of chronic diseases: results from the first 8 years of follow-up in the EPIC-Potsdam study.Eur J Clin Nutr. 2013; 67: 412-419
- Association between dairy food consumption and risk of myocardial infarction in women differs by type of dairy food.J Nutr. 2013; 143: 74-79
- Consumption of dairy products and death from cardiovascular disease in the Japanese general population: the NIPPON DATA80.J Epidemiol. 2013; 23: 47-54
- Still questioning the association between egg consumption and the risk of cardiovascular diseases.Atherosclerosis. 2012; 224: 318-319
- Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies.Brit Med J. 2013; 346: e8539
- Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis.Am J Clin Nutr. 2013; 98: 146-159
- Egg consumption and risk of cardiovascular diseases and diabetes: a meta-analysis.Atherosclerosis. 2013; 229: 524-530
- Olive oil and CVD: accruing evidence of a protective effect.Br J Nutr. 2012; 108: 1931-1933
- Olive oil consumption, plasma oleic acid, and stroke incidence: the three-city Study.Neurology. 2011; 77: 418-425
- Fruit, vegetables, and olive oil and risk of coronary heart disease in Italian women: the EPICOR Study.Am J Clin Nutr. 2011; 93: 275-283
- Olive oil intake and mortality within the Spanish population (EPIC-Spain).Am J Clin Nutr. 2012; 96: 142-149
- Olive oil intake and CHD in the European Prospective Investigation into Cancer and Nutrition Spanish cohort.Br J Nutr. 2012; 108: 2075-2082
- Primary prevention of cardiovascular disease with a Mediterranean diet.N Engl J Med. 2013; 368: 1279-1290
- Health benefits of nut consumption.Nutrients. 2010; 2: 652-682
- A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study.Arch Intern Med. 1992; 152: 1416-1424
- Effects of walnuts on serum lipid levels and blood pressure in normal men.N Engl J Med. 1993; 328: 603-607
- Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review.Am J Clin Nutr. 2009; 90: 56-63
- Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials.Arch Intern Med. 2010; 170: 821-827
- Nuts and coronary heart disease: an epidemiological perspective.Br J Nutr. 2006; 96: S61-S67
- The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?.Am J Clin Nutr. 2011; 93: 684-688
- Consumption of nuts and legumes and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis.Am J Clin Nutr. 2014; (In Press)
- Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation.(Geneva)916. 2003: i-viii
- Food, nutrition, physical activity, and the prevention of cancer: a global perspective.AICR, Washington DC2007
- The environment and disease: association or causation?.Proc R Soc Med. 1965; 58: 295-300
Article info
Publication history
Published online: March 27, 2014
Accepted:
March 16,
2014
Received in revised form:
March 11,
2014
Received:
December 22,
2013
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
