Replacing saturated fatty acids with polyunsaturated fatty acids prevents coronary heart disease over a wide range of intakes
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It is not established whether energy from unsaturated fatty acids or carbohydrates should replace energy from saturated fatty acids (SFAs) in order to decrease coronary heart disease (CHD) risk. This follow-up study including pooled data of 344,696 subjects from 11 American and European cohort studies aimed to investigate associations between energy intake from monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and carbohydrates and risk of CHD. A total of 5249 coronary events and 2155 coronary deaths were observed during the 4-10 year follow-up period. For a 5% lower energy intake from SFAs and a concomitant higher energy intake from polyunsaturated fatty acids (PUFAs), a significant inverse association between PUFAs and risk of coronary events was noted, the hazard ratio for coronary deaths being 0.74. For a 5% lower energy intake from SFAs and a concomitant higher energy intake from carbohydrates, a modest significant direct association between carbohydrates and coronary events was observed, the hazard ratio for coronary deaths being 0.96. There was no association between MUFA intake and CHD. No effect modification by sex or age was found. These associations suggest that replacing SFAs with PUFAs rather than MUFAs or carbohydrates prevents CHD over a wide range of intakes.
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