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Saturated vs Unsaturated Fats and CHD

Study also looks at sources of carbohydrates

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A reduced risk of coronary heart disease (CHD) can be achieved by replacing saturated fats with unsaturated fats, especially polyunsaturated fatty acids (PUFAs), and/or high-quality carbohydrates, according to a study of 84,628 women and 42,908 men. During 24 to 30 years of follow-up, 7,667 incident cases of CHD were documented. The study also found:

• Higher intakes of PUFAs and carbohydrates from whole grains were significantly associated with lower risk of CHD comparing the highest with lowest quintile for PUFAs (HR, 0.80) and for carbohydrates from whole gains (HR, 0.90).

• Carbohydrates from refined starches/added sugars were positively associated with a risk of CHD (HR, 1.10).

• Replacing 5% of energy intake from saturated fats with equivalent energy intake from PUFAs, monounsaturated fatty acids, or carbohydrates from whole grains was associated with a 25%, 15%, and 9% lower risk of CHD, respectively.

Citation: Li Y, Hruby A, Bernstein AM, et al. Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease. Am Coll Cardiol. 2015;66(14):1538-1548. doi:10.1016/j.jacc.2015.07.055.

Commentary: A previous meta-analysis showed that substituting SFA with carbohydrates did not decrease CV risk, but that study did not distinguish the type of carbohydrate that was substituting for the SFA.1 This study shows that it is not just the substitution of saturated fats with carbohydrate that influences effect on cardiovascular (CV) outcomes, but that it matters what type of carbohydrate is used in that substitution. Diets high in low glycemic index (GI) carbohydrates, which are predominantly carbohydrates from whole grains, appear to decrease the risk of CV disease and type 2 DM compared to diets high in GI carbs.2 From a practical point-of-view, when we suggest decreasing SFA in the diet, we need to be specific about what should replace the SFA calories, and it appears that PUFAs and carbohydrates from whole grains are a good choice and can lead to improved health outcomes and lower CV risk. —Neil Skolnik, MD

1. Jakobsen MU, O’Reilly EJ, Heitmann BL, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr. 2009;89:1425–1432.

2. Barclay AW, Petocz P, McMillan-Price J, et al. Glycemic index, glycemic load, and chronic disease risk – a meta-analysis of observational studies. Am J Clin Nutr. 2008;87:627–637.

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