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Saturated Fat and Cardiovascular Disease

The Evidence

In a 2009 systematic review, the following summary of evidence from prospective cohort studies and randomized controlled trials was provided:¹

• From the meta-analysis of cohort studies of saturated fat and coronary heart disease, intake of saturated fatty acids was not significantly associated with coronary heart disease death or events;
• The relative risks for the highest compared to the lowest category of saturated fat intake were 1.14 (95% CI: 0.82-1.60, p = 0.431) for coronary heart disease mortality and 0.93 (95% CI: 0.83-1.05, p = 0.269) for coronary heart disease events;
• There was no significant association between saturated fat and coronary heart disease death or events per 5% total energy increase in saturated fatty acids intake;
• From the meta-analysis of randomized controlled trials of dietary fat and coronary heart disease, the relative risk of fatal coronary heart disease was not reduced by fat-modified diets.

Another systematic review of prospective cohort studies and randomized trials examined the evidence for dietary factors in relation to coronary heart disease.²

• Pooled analyses of cohort studies did not show any significant association between higher intakes of saturated fatty acids, meat or milk and coronary heart disease;
• The relative risks were 1.06 (95% CI: 0.96-1.15) for saturated fatty acids, 1.23 (95% CI: 0.98-1.49) for meat, and 0.94 (95% CI: 0.75-1.13) for milk;
• After the dietary exposures were stratified by confounding variables such as dietary assessment tool, sex, geographic region, and type of prevention strategy, the association between saturated fatty acids and coronary heart disease in cohort studies remained statistically insignificant;
• There was no evidence from pooled analyses of randomized controlled trials to support a causal association between saturated fatty acids, meat or milk and coronary heart disease.

A 2010 meta-analysis of prospective cohort studies, which included the follow-up of 347,747 subjects during 5 to 23 years, provided the following evidence on the association between dietary saturated fat and coronary heart disease, stroke, and cardiovascular disease:³

• Saturated fat intake was not associated with an elevated risk of coronary heart disease, stroke or cardiovascular disease;
• The pooled relative risks were 1.07 (95% CI: 0.96-1.19, p = 0.22) for coronary heart disease, 0.81 (95% CI: 0.62-1.05, p = 0.11) for stroke, and 1.00 (95% CI: 0.89-1.11, p = 0.95) for cardiovascular disease;
• After adjustments for covariates such as age, sex and study quality, the results did not change and no significant association was observed;
• No association between dietary saturated fat and disease prevalence was found after adjustment for other nutrients and total energy.

In a prospective cohort study published in 2010, the association between saturated fatty acid intake and the risk of cardiovascular disease mortality was investigated in 58,453 Japanese adults aged 40 to 79 years.⁴

• Dietary saturated fatty acid intake was inversely associated with risk of total stroke, intraparenchymal hemorrhage and ischemic stroke;
• After adjustments for confounding variables such as potential cardiovascular disease risk factors and nutrients, the hazard ratios for the highest compared with lowest quintile were 0.69 (95% CI: 0.53-0.89, p_trend = 0.004) for total stroke, 0.48 (95% CI: 0.27-0.85, p_trend = 0.03) for intraparenchymal hemorrhage, and 0.58 (95% CI: 0.37-0.90, p_trend = 0.01) for ischemic stroke;
• There was no association between saturated fatty acids intake and subarachnoid hemorrhage and heart diseases such as ischemic heart disease, cardiac arrest and heart failure.

Conclusion

There is strong evidence from new studies to support the lack of association between dietary saturated fat and cardiovascular disease.

Further research on dietary patterns in cohort studies and randomized clinical trials is needed to evaluate the relationship between the intake of nutrients or food components and cardiovascular disease outcomes or mortality in the population.

For more information:

• Replacement of Saturated Fat with Other Nutrients
• Saturated Fat and Cardiovascular Disease Risk Factors

Keywords: cardiovascular disease, coronary heart disease, dietary factors, saturated fat, stroke

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