Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease
Open accessAbstract
Background The associations between dietary saturated fats and the risk of coronary heart disease (CHD) remain controversial, but few studies have compared saturated with unsaturated fats and sources of carbohydrates in relation to CHD risk.Objectives This study sought to investigate associations of saturated fats compared with unsaturated fats and different sources of carbohydrates in relation to CHD risk.Methods We followed 84,628 women (Nurses' Health Study, 1980 to 2010), and 42,908 men (Health Professionals Follow-up Study, 1986 to 2010) who were free of diabetes, cardiovascular disease, and cancer at baseline. Diet was assessed by a semiquantitative food frequency questionnaire every 4 years.Results During 24 to 30 years of follow-up, we documented 7,667 incident cases of CHD. Higher intakes of polyunsaturated fatty acids (PUFAs) and carbohydrates from whole grains were significantly associated with a lower risk of CHD comparing the highest with lowest quintile for PUFAs (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.73 to 0.88; p trend <0.0001) and for carbohydrates from whole grains (HR: 0.90, 95% CI: 0.83 to 0.98; p trend = 0.003). In contrast, carbohydrates from refined starches/added sugars were positively associated with a risk of CHD (HR: 1.10, 95% CI: 1.00 to 1.21; p trend = 0.04). 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 (PUFAs, HR: 0.75, 95% CI: 0.67 to 0.84; p < 0.0001; monounsaturated fatty acids, HR: 0.85, 95% CI: 0.74 to 0.97; p = 0.02; carbohydrates from whole grains, HR: 0.91, 95% CI: 0.85 to 0.98; p = 0.01). Replacing saturated fats with carbohydrates from refined starches/added sugars was not significantly associated with CHD risk (p > 0.10).Conclusions Our findings indicate that unsaturated fats, especially PUFAs, and/or high-quality carbohydrates can be used to replace saturated fats to reduce CHD risk.
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Replacement of 5% of energy from SFA with PUFA is associated with a 25% lower risk of coronary artery disease.
“Replacement of 5% of energy from SFA with PUFA is associated with a 25% lower risk of coronary artery disease [10].”
Substituting 5% of energy intake from saturated fats with an equal amount of energy from polyunsaturated fats, monounsaturated fats, or carbohydrates from whole grains is associated with a 25%, 15%, and 9% lower risk of coronary heart disease, respectively.
“It has been estimated that substituting 5% of energy intake from saturated fats with an equal amount of energy from polyunsaturated fats, monounsaturated fats, or carbohydrates from whole grains is associated with a 25%, 15%, and 9% lower risk of coronary heart disease, respectively.”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [34]
Replacing saturated fats with carbohydrates from refined grains is associated with an increased risk of coronary heart disease.
“In contrast, replacing saturated fats with carbohydrates from refined grains is associated with an increased risk of coronary heart disease (34).”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [34]
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“Replacement of 5% of energy from SFA with PUFA is associated with a 25% lower risk of coronary artery disease [10].”
- Authors
- Li, Y., Hruby, A., Bernstein, A. M., Ley, S. H., Wang, D. D., Chiuve, S. E., Sampson, L., Rexrode, K. M., Rimm, E. B., Willett, W. C., & Hu, F. B.
- Affiliations
- Harvard University (US)
- Cleveland Clinic (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Hu, Frank B.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 66
- Issue
- 14
- Pages
- 1538-1548
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC4593072
- OpenAlex
- W1749005812
- Cited by
- 539
- References
- 26
- Citations by year
- 2026: 29 · 2025: 41 · 2024: 42 · 2023: 50 · 2022: 59 · 2021: 55 · 2020: 57 · 2019: 49 · 2018: 60 · 2017: 42 · 2016: 47 · 2015: 6
- FWCI
- 54.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institutes of Health (CA-167552)
- National Heart, Lung, and Blood Institute (R01HL060712, R01HL035464, R01HL034594)
- National Cancer Institute (UM1CA186107, UM1CA167552)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- saturated fat, unsaturated fat, polyunsaturated fatty acids, monounsaturated fatty acids, whole grains, added sugars, dietary carbohydrates, coronary heart disease risk, fat replacement, Nurses' Health Study, Health Professionals Follow-up Study, prospective cohort, cardiovascular disease prevention, dietary habits, men and women, food frequency questionnaire, incident coronary heart disease
- MeSH terms
- Adult, Aged, Energy Intake, Coronary Artery Disease, Diet Surveys, Dietary Carbohydrates, Dietary Fats, Unsaturated, Feeding Behavior, Female, Follow-Up Studies, Food Preferences, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, United States, Incidence, Self Report
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