1. Cholesterol and Cardiac Mortality Myth & TruthFayza
RayesMBBCh. Msc. MRCGP Consultant Family PhysicianJoint Program of
Family & Community Medicine, Jeddah www.fayzarayes.com
2. The MythPeople consume high fat diet havehigh cardiac
mortality 3. The Original EvidenceAncel Keys cheated.He selected
data from 6 countries to create thelinear relationship. Data were
actually available from total of22 countries!This is the graph of
heart deathsKeys (1953). Journal of mountSinai Hospital New
Yorkplotted against fat intake 4. Consumption of fat and cardiac
mortalityWe can make it astraight line, itshows very
clearpositivecorrelation: 5. Consumption of fat and cardiac
mortalityChoosing a fewother countriesmight havegiven
anegativecorrelation: 6. Consumption of fat and cardiac
mortalityChoosing a fewother countriesthe negativecorrelationbecome
moreclear(consumption of>40% ofcalories from fatassociated
withlower cardiacmortality): 7. Consumption of fat and cardiac
mortality So lets look at the whole database from which Keys
carefully selected his six countries 8. Consumption of fat and
cardiac mortalityCmpare to the originalline swept in by Keys.Things
get worse ifyou add in the Masai,the Inuit, the Rendile,the Tokelau
and a fewothers, shown as reddots: 9. Cholesterol and Cardiac
MortalityOther Studies Do people who eat more saturated fat have
more heart attacks? The following are high-impact prospective
studies, showing noassociation between saturated fat consumption
and heart attack risk. 10. Cholesterol and cardiac mortalityBetween
nationstudies this figure,credited to Dr.Kendrick, showsthe rates
of deathfrom CHD plottedagainst the percentof a givenpopulation who
arefranklyhypercholesterola--emic. Heextracted the datafrom
MONICAstudy 11. NegativeCorrelationWHO-MONICA Study- Multinational
MONItoring of Trends anddetermination in CArdiovascular Disease; a
10 year study, 7million people,14 European countries plus the
AustralianAborigines (Aborigines are the leftmost
country-lowestcholesterol & highest death rate). 12. BMJ. 1996
Jul 13;313(7049):84-90.Dietary fat and risk of coronary heart
disease in men: cohort follow up study in the USAAscherio A, Rimm
EB, Giovannucci EL, Spiegelman D, StampferM, Willett WC.Source:
Harvard School of Public Health, Boston, MA 02115, USA.OBJECTIVE:
To examine the association between fat intake and theincidence of
coronary heart disease in men of middle age and older.DESIGN:
Cohort questionnaire study of men followed up for six yearsfrom
1986.SETTING: The health professionals follow up study in the
United States.SUBJECTS: 43 757 health professionals aged 40 to 75
years free ofdiagnosed cardiovascular disease or diabetes in
1986.MAIN OUTCOME MEASURE: Incidence of acute myocardial infarction
orcoronary death. 13. RESULTS: During follow up 734 coronary events
weredocumented, including 505 non-fatal myocardial infarctions and
229deaths. After age and several coronary risk factors were
controlled forsignificant positive associations were observed
between intake ofsaturated fat and risk of coronary disease. For
men in the top versusthe lowest fifth of saturated fat intake
(median = 14.8% v 5.7% ofenergy) the multivariate relative risk for
myocardial infarction was 1.22(95% confidence interval 0.96 to
1.56) and for fatal coronary heartdisease was 2.21 (1.38 to 3.54).
After adjustment for intake of fibrethe risks were 0.96 (0.73 to
1.27) and 1.72 (1.01 to 2.90), respectively.Positive associations
between intake of cholesterol and risk ofcoronary heart disease
were similarly attenuated after adjustment forfibre intake. Intake
of linolenic acid was inversely associated with riskof myocardial
infarction; this association became significant only
afteradjustment for non-dietary risk factors and was strengthened
afteradjustment for total fat intake (relative risk 0.41 for a 1%
increase inenergy, P for trend < 0.01). 14. CONCLUSIONS: These
data do not support the strong association between intake of
saturated fat and risk of coronary heart disease suggested by
international comparisons. They are compatible, however, with the
hypotheses that saturated fat and cholesterol intakes affect the
risk of coronary heart disease as predicted by their effects on
blood cholesterol concentration. They also support a specific
preventive effect of linolenic acid intake. 15. J Intern Med. 2005
Aug;258(2):153-65.Dietary fat intake and early mortality
patterns--data fromThe Malm Diet and Cancer Study.Leosdottir M,
Nilsson PM, Nilsson JA, Mnsson H, Berglund G.Source : Department of
Medicine, Lund University, University Hospital (UMAS),Malm, Sweden.
[email protected]: Most current dietary
guidelines encourage limiting relative fatintake to
