Saturated fat lessens risk of heart disease in post-menopausal women

A new finding, published in the American Journal of Clinical Nutrition, is that eating saturated fat reduces the progression of cardiovascular disease in post-menopausal women. They call it "The American Paradox". It is the latest in a long line of "paradoxes" — French, Greek, Spanish, etc — where people in countries that eat lots of fat — and saturated fat at that — don't get the heart disease that American doctors think they should. How dare these people make a mockery of American hypotheses?

It never ceases to amaze me that, with all the evidence over the last fifty years that saturated fats are NOT unhealthy, American doctors and, it must be admitted, others influenced by American ideas, cannot seem to put two and two together to make four.

Below is the abstract from that study:

Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women

Dariush Mozaffarian, Eric B Rimm, and David M Herrington

ABSTRACT

Background: The influence of diet on atherosclerotic progression is not well established, particularly in postmenopausal women, in whom risk factors for progression may differ from those for men.

Objective: The objective was to investigate associations between dietary macronutrients and progression of coronary atherosclerosis among postmenopausal women.

Design: Quantitative coronary angiography was performed at baseline and after a mean follow-up of 3.1 y in 2243 coronary segments in 235 postmenopausal women with established coronary heart disease. Usual dietary intake was assessed at baseline.

Results: The mean total fat intake was 25 +/- 6% of energy. In multivariate analyses, a higher saturated fat intake was associated with a smaller decline in mean minimal coronary diameter (P = 0.001) and less progression of coronary stenosis (P = 0.002) during follow-up. Compared with a 0.22-mm decline in the lowest quartile of intake, there was a 0.10-mm decline in the second quartile (P = 0.002), a 0.07-mm decline in the third quartile (P = 0.002), and no decline in the fourth quartile (P <0.001); P for trend = 0.001. This inverse association was more pronounced among women with lower monounsaturated fat (P for interaction = 0.04) and higher carbohydrate (P for interaction = 0.004) intakes and possibly lower total fat intake (P for interaction = 0.09). Carbohydrate intake was positively associated with atherosclerotic progression (P = 0.001), particularly when the glycemic index was high. Polyunsaturated fat intake was positively associated with progression when replacing other fats (P = 0.04) but not when replacing carbohydrate or protein. Monounsaturated and total fat intakes were not associated with progression.

Conclusions: In postmenopausal women with relatively low total fat intake, a greater saturated fat intake is associated with less progression of coronary atherosclerosis, whereas carbohydrate intake is associated with a greater progression.

Am J Clin Nutr 2004;80: 1175?84.

Now there's a surprise! This is what I have been preaching now for over 33 years — and what I have been castigated and vilified for saying!
But they could also have said that the same applies to pre-menopausal women and to women who eat a higher fat diet than the ones in this study. No doubt they will, when they have wasted more time and money doing (more of) such studies. Other quotes from the paper are:

"Among postmenopausal women with established CHD, greater saturated fat intake was associated with less progression of coronary atherosclerosis over an average follow-up of 3 y, whereas polyunsaturated fat and carbohydrate intakes were associated with greater progression."

"The magnitude, independence, and consistency of the inverse association between saturated fat intake and atherosclerotic progression are notable. Are there plausible biologic mechanisms for such an effect? In contrast with the findings of experimental studies, saturated fat intake was not associated with LDL concentrations in our study."

"A greater saturated fat intake was associated with other lipid differences, including higher HDL, . . . and a lower TC:HDL cholesterol ratio. These findings are consistent with those of experimental studies that showed unfavorable effects of low-fat, low-saturated-fat diets on HDL cholesterol,. . ."

"Carbohydrate intake was positively associated with atherosclerotic progressionwhenreplacing saturated fat and monounsaturated fat but not when replacing total fat, polyunsaturated fat, or protein. The association was perhaps stronger among women with lower physical activity, who would be more susceptible to adverse effects of carbohydrates — particularly refined carbohydrate — on HDL cholesterol, triacylglycerols, glucose metabolism, insulin sensitivity, and weight gain. Consistent with such biologic mechanisms, the relation between carbohydrate intake and atherosclerotic progression appeared to be stronger in women with a higher glycemic index."

"Polyunsaturated fat intake was not associated with atherosclerotic progression when replacing carbohydrate or protein but was positively associated when replacing other fats, especially saturated fat."

"Our findings also suggest that carbohydrate intake may increase atherosclerotic progression, especially when refined carbohydrates replace saturated or monounsaturated fats."

In an editorial about this paper, Drs Robert H Knopp and Barbara M Retzlaff state: "It is an article of faith that saturated fat raises LDL cholesterol and accelerates coronary artery disease, whereas unsaturated fatty acids have the opposite effect."

They are right; that is all this idea has been since the idea was first floated in 1953 (see THE CHOLESTEROL MYTH, Part 2: Dietary Fats and Heart Disease). It has never been proven.

So, the bottom line is: if you want to avoid heart disease, don't cut down on saturated and monounsaturated fats and replace them with carbohydrates and polyunsaturated fats!