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Cardiovascular Disease and Milk Products: Summary of Evidence

Synopsis

A growing body of scientific evidence indicates that milk product consumption may reduce the risk of cardiovascular disease. In fact, recent evidence suggests the saturated fatty acids found in milk products are not detrimental to health; and, that full-fat dairy foods, such as regular-fat cheese, may help to protect cardiovascular health. This has led researchers to conclude that current evidence does not support a focus on low-fat dairy foods in dietary guidance.

In addition, there are numerous milk components that may be related to the prevention or management of cardiovascular risk factors, including: vitamin D, calcium, potassium, magnesium, phosphorus, protein and bioactive peptides, and dairy fatty acids.

The Evidence

A meta-analysis of 27 prospective cohort studies, published by Gholami et al. in 2017, evaluated the association of the consumption of dairy products on cardiovascular disease.¹

• Dairy consumption was associated with a 10% lower risk of cardiovascular disease and a 12% lower risk of stroke.
• Dairy consumption was also associated with a 20% lower risk of mortality from stroke.
• No association was observed between total dairy intake and coronary heart disease.

A meta-analysis of 31 prospective cohort studies, published in 2016 by Alexander et al., examined the association between dairy consumption and the risk of cardiovascular disease.2

• Dairy consumption, including full-fat dairy, was associated with a 9% reduced risk of stroke;
• Calcium from dairy sources was associated with a 31% lower risk of stroke;
• Cheese was associated with an 18% and 13% reduced risk of coronary heart disease and stroke, respectively.

In 2016, Drouin-Chartier et al. published a systematic review of meta-analyses of prospective cohort studies which provides an in-depth perspective on the associations between dairy product consumption and the risk of cardiovascular-related clinical outcomes.³ This review concluded there is no evidence that the consumption of any form of dairy is detrimentally associated with any cardiovascular-related clinical outcome. In fact:

• High quality evidence indicates total dairy consumption is associated with a lower risk of hypertension;
• High quality evidence indicates low-fat dairy and yogurt intakes are associated with a lower risk of type 2 diabetes;
• Moderate-quality evidence suggests total dairy food consumption is associated with a lower risk of stroke, metabolic syndrome and type 2 diabetes;
• High to moderate quality evidence indicates the consumption of regular and high-fat dairy does not increase the risk of coronary artery disease, stroke, hypertension or type 2 diabetes.

In 2016, Drouin-Chartier et al. also published a comprehensive review of the evidence from randomized controlled trials examining the impact of dairy foods and dairy fat on cardiometabolic risk factors including blood-lipids, blood pressure, insulin resistance and vascular function.⁴ This review suggests the focus on low-fat dairy foods instead of regular-fat dairy foods in dietary guidelines is unwarranted.

• Increasing consumption of dairy foods generally has no significant effect on LDL cholesterol, regardless of their form or fat content;
• Dairy food consumption has no effect on HDL cholesterol or triglyceride concentrations;
• Consumption of dairy foods and dairy fat does not appear to impact systemic inflammation;
• Dairy consumption has no impact on insulin resistance and glucose and insulin homeostasis in the short term; however, may be beneficial in the long-term.
• Most randomized controlled trials have shown no effect of dairy on blood pressure or vascular function; however, the authors note these results are not consistent with epidemiological evidence that dairy food consumption is associated with a reduced risk of hypertension.

A meta-analysis of 15 prospective cohort studies, published in 2016 by Chen et al. evaluated associations between cheese consumption and the risk of cardiovascular disease, coronary heart disease and stroke. Most of the studies (13/15) followed participants for more than 10 years.⁵

• Higher compared with lower cheese consumption was associated with a 14% lower risk of coronary heart disease and a 10% lower risk of stroke and total cardiovascular disease.  
• The largest reductions in cardiovascular disease risk were observed with consumption of about 40 g of cheese per day.

The landmark PURE (Prospective Urban Rural Epidemiology) study, assessed the associations between dairy food consumption and the risk of major cardiovascular disease events (i.e., heart attack, stroke, heart failure and death due to cardiovascular causes). This study, published in 2018 based on data from 136,000 adults from 21 countries on 5 continents, followed for a median of 9.1 years, concluded:⁶

• Dairy food consumption (>2 servings/day vs 0) was associated with a 22% lower risk of cardiovascular disease and a 34% lower risk of stroke;
• Milk consumption (>1 serving/day vs 0) was associated with an 18% lower risk of cardiovascular disease;
• Yogurt consumption (>1 serving/day vs 0) was associated with a 10% lower risk of cardiovascular disease;
• Full-fat dairy consumption(>1 serving/day vs 0) was associated with a 32% lower risk of cardiovascular disease.

Potential Mechanisms

The consumption of dairy products has been inversely associated with several risk factors for cardiovascular disease, including hypertension, obesity, diabetes and inflammation.

The effects of dairy foods may be mediated by a number of specific micronutrients, amino acids, fatty acids, and probiotics.⁷  

Several nutrients found in dairy products may be beneficial to cardiovascular health (summarized in the table below).^8,9 Furthermore, there is evidence to suggest that the complex matrix of dairy foods as a whole rather than just individual components may be as important to improving cardiovascular health.⁸

Conclusion

Current evidence indicates that milk products are not associated with an increased cardiovascular risk, regardless of their fat content.

In fact, a growing body of evidence suggests the consumption of dairy foods, including milk, cheese and yogurt, can help to protect cardiovascular health.

In addition, current evidence does not appear to support continued dietary guidance to choose lower fat dairy foods instead of full-fat dairy foods, such as regular-fat cheese.

Milk products are complex foods containing many key nutrients. Additional mechanistic studies are needed to fully understand how these components or the dairy food matrix may help reduce cardiovascular risk.

Keywords: cardiovascular disease , saturated fat , coronary heart disease , stroke , bioactive peptides , conjugated linoleic acid