Practice Update - ESC Congress 2017

Two Results of the PURE StudyMay Be Game Changers inHeart Disease Prevention

Global dietary guidelines on fat intake and recommendations for high intake of fats, vegetables, and legumes to reduce cardiovascular risk and mortality need to be revisited. This conclusion, based on results of the Prospective Urban-Rural Epidemiology (PURE) study of 135,335 individuals age 35 to 70 years, from countries in North America, Europe, South America, the Middle East, South Asia, China, Southeast Asia, and Africa, was presented at the 2017 European Society of Cardiology (ESC) Congress, from August 26–30.

M ahshid Dehghan, PhD, and Andrew Mente, PhD, of the Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada, reported on this study of 135,535 individu- als, age 35–70 years, from 18 low-, middle-, and high-income countries. Dr. Dehghan said that data from the study showed that high carbohydrate intake is linked to worse total mortality and noncar- diovascular mortality outcomes, while high fat intake is associated with lower risk. "Limiting total fat consumption is unlikely to improve health in populations, and a total fat intake of approximately 35% of energy with concomitant lowering of carbohydrate intake may lower risk of total mortality," Dr. Dehghan said. "In fact, individuals with high carbohydrate intake, above 60% of energy, may benefit from a reduction in carbohydrate intake and an increase in the consumption of fats.” Consumption of carbohydrate, total fat, and types of fat were recorded using country-spe- cific, validated food frequency questionnaires, and associations with cardiovascular disease and mortality were assessed. Among 5796 deaths and 4784 major cardiovascular events over a median follow-up of 7.4 years, carbohydrate intake

in the highest vs lowest quintile was associated with a significant, 28% increased risk of total mortality (hazard ratio 1.28; 95% confidence interval 1.12–1.46, highest vs lowest quintile category, P ≤ .0001) but not cardiovascular risk. Conversely, total fat intake in the highest vs lowest quartile was associated with a signif- icant, 23% reduction of total mortality risk, an 18% reduced risk of stroke, and a 30% reduced risk of noncardiovascular mortality. Each type of fat was associated with sig- nificantly reduced mortality risk: 14% lower for saturated fat, 19% for monounsaturated fat, and 20% for polyunsaturated fat. Higher saturated fat intake was also associated with a 21% decrease in stroke risk. Dr. Dehghan and colleagues also examined the impact of fats and carbohydrates on blood lipids. Consistent with other reports fromWestern countries, they found that while LDL increases with higher intakes of saturated fat, HDL also increases. So the net effect is a decrease in the total cholesterol/HDL ratio. They found that LDL cholesterol (the basis of many dietary guidelines) is not reliable in predicting effects of saturated fat on future

Dr. Mahshid Dehghan

Dr. Andrew Mente

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