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Meat, Fish, Dairy, Eggs and Ischemic Heart Disease Risk
Study Questions:
Does consumption of animal foods including meat, fish, and dairy increase the risk for ischemic heart disease (IHD)?
Methods:
Data from the pan-European EPIC (European Prospective Investigation into Cancer and Nutrition) cohort were used for the present analysis. EPIC is a prospective study of 520,000 men and women through 23 centers in 10 European countries between 1992 and 2000. Diet was assessed using validated country-specific questionnaires, which were calibrated with 24-hour dietary recalls. Additional cardiovascular (CV) risk factors included lipids and blood pressure, which were measured in a subsample of the cohort. Nonfatal myocardial infarctions (MIs) were assessed through record linkage with hospital registries or self-report then confirmed through the medical record. IHD mortality was collected through registries at the regional or national level. Associations between intake of animal foods and risk for IHD were adjusted for other animal foods and relevant covariates including age, smoking status, physical activity, CV risk factors, education level, body mass index (BMI), alcohol consumption, fiber intake, fruit and vegetable intake, and total energy intake.
Results:
A total of 409,885 participants were followed for a mean of 12.6 years, during which 7,198 MIs or IHD-related deaths were identified. Cases were more likely to be older, smoke, be sedentary, have a higher BMI, be unemployed, and have CV risk factors such as diabetes, elevated blood pressure, or proatherogenic lipid profiles. Cases were also more likely to report a lower consumption of fruits and vegetables. For every 100 g/d increase in red and processed meat consumption, there was a 19% increase in risk for IHD (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.06-1.33), which remained significant after excluding the first 4 years of follow-up (HR, 1.25; 95% CI, 1.09-1.42). IHD risk was inversely associated with intake of yogurt (HR, 0.93; 95% CI, 0.89-0.98 per 100 g/d increment), cheese (HR 0.92; 95% CI, 0.86-0.98 per 30 g/d increment), and egg consumption (HR, 0.93; 95% CI, 0.88-0.99 per 20 g/d increment). Associations with yogurt and eggs were attenuated and nonsignificant after excluding the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese, or eggs was associated with approximately 20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non–high-density lipoprotein (non-HDL) cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-HDL cholesterol.
Conclusions:
The investigators concluded that risk for IHD was positively associated with consumption of red and processed meat, and inversely associated with consumption of yogurt, cheese, and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non-HDL cholesterol, and for red and processed meat with systolic blood pressure, which could mediate such effects.
Perspective:
These data suggest that reducing intake of red and processed meats may have benefits for lowering IHD risk. As with any nonrandomized cohort, residual confounding cannot be eliminated; however, the investigators have adjusted for many risk factors and lifestyle factors that are potential confounders. Furthermore, the results may not be generalizable to other countries; in particular where cultural differences in diet may differ from those of most European countries. Nevertheless, this large cohort and well-done analysis support dietary patterns high in fruits and vegetables and low in red and processed meats.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet, Exercise, Smoking
Keywords: Blood Pressure, Body Mass Index, Cheese, Cholesterol, Dairy Products, Diabetes Mellitus, Diet, Exercise, Fruit, Sedentary Behavior, Lipids, Lipoproteins, Meat, Milk, Myocardial Infarction, Myocardial Ischemia, Neoplasms, Poultry, Primary Prevention, Risk Factors, Smoking, Vegetables, Yogurt
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