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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
Two Results of the PURE
StudyMay Be Game Changers
inHeart Disease Prevention
Dr. Mahshid Dehghan
Dr. Andrew Mente
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.
PRACTICEUPDATE CONFERENCE SERIES • ESC Congress 2017
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