Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease
Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of 7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort
Timothy J. Key1, Paul N Appleby1, Kathryn E Bradbury 1,2, Michael Sweeting3, Angela Wood3 et al.
1 Nuffield Department of Population Health, University of Oxford, Oxford, UK
2 National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
3 MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
There is uncertainty about the relevance of animal foods to the etiology of ischemic heart disease (IHD). We examined meat, fish, dairy products and eggs and risk for Ischemic Heart Disease (IHD) in the pan-European EPIC cohort.
Methods: A prospective study of 409,885 men and women in nine European countries. Diet was assessed using validated questionnaires, calibrated using 24-hour recalls. Lipids and blood pressure were measured in a subsample. During 12.6 years mean follow up, 7198 participants had a myocardial infarction or died from IHD. The relationships of animal foods with risk were examined using Cox regression with adjustment for other animal foods and relevant covariates.
Results: The hazard ratio (HR) for IHD was 1.19 (95% CI 1.06-1.33) for a 100 g/d increment in intake of red and processed meat, and this remained significant after excluding the first 4 years of follow-up (HR 1.25 [1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR 0.93 [0.89-0.98] per 100 g/d increment), cheese (HR 0.92 [0.86-0.98] per 30 g/d increment) and eggs (HR 0.93 [0.88-0.99] per 20 g/d increment); the associations with yogurt and eggs were attenuated and non-significant after excluding the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish or milk. In analyses modelling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese or eggs was associated with approximately 20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-HDL cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-HDL cholesterol.
Conclusions: Risk for IHD was positively associated with consumption of red and processed meat, and inversely associated with consumption of yogurt, cheese and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non-HDL cholesterol, and for red and processed meat with systolic blood pressure, which could mediate such effects.
What is this new research?
• We followed the health of 400,000 men and women in nine European countries for 12 years to examine the relevance of intake of animal foods to the etiology of ischemic heart disease.
• Higher consumption of red and processed meat was positively associated with the risk for ischemic heart disease.
• None of the other animal foods examined were positively associated with risk; intakes of fatty fish, yogurt, cheese and eggs were modestly inversely associated with risk.
What are the clinical implications?
• Higher intake of red and processed meat may increase risk of ischemic heart disease.
• Substituting other foods for red and processed meat may reduce risk of ischemic heart disease
Publication details
Key, T.J., Appleby, P.N., Bradbury, K.E., Sweeting, M., Wood, A., et al. 2019. Consumption of Meat, Fish, Dairy Products, Eggs and Risk of Ischemic Heart Disease: A Prospective Study of 7198 Incident Cases Among 409,885 Participants in the Pan-European EPIC Cohort. Circulation https://doi.org/10.1161/CIRCULATIONAHA.118.038813