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Christensen JJ, Arnesen EK, Rundblad A, Telle-Hansen VH, Narverud I, Blomhoff R, Bogsrud MP, Retterstøl K, Ulven SM, Holven KB. Dietary fat quality, plasma atherogenic lipoproteins, and atherosclerotic cardiovascular disease: An overview of the rationale for dietary recommendations for fat intake. Atherosclerosis 2024; 389:117433. [PMID: 38219649 DOI: 10.1016/j.atherosclerosis.2023.117433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
The scientific evidence supporting the current dietary recommendations for fat quality keeps accumulating; however, a paradoxical distrust has taken root among many researchers, clinicians, and in parts of the general public. One explanation for this distrust may relate to an incomplete overview of the totality of the evidence for the link between fat quality as a dietary exposure, and health outcomes such as atherosclerotic cardiovascular disease (ASCVD). Therefore, the main aim of the present narrative review was to provide a comprehensive overview of the rationale for dietary recommendations for fat intake, limiting our discussion to ASCVD as outcome. Herein, we provide a core framework - a causal model - that can help us understand the evidence that has accumulated to date, and that can help us understand new evidence that may become available in the future. The causal model for fat quality and ASCVD is comprised of three key research questions (RQs), each of which determine which scientific methods are most appropriate to use, and thereby which lines of evidence that should feed into the causal model. First, we discuss the link between low-density lipoprotein (LDL) particles and ASCVD (RQ1); we draw especially on evidence from genetic studies, randomized controlled trials (RCTs), epidemiology, and mechanistic studies. Second, we explain the link between dietary fat quality and LDL particles (RQ2); we draw especially on metabolic ward studies, controlled trials (randomized and non-randomized), and mechanistic studies. Third, we explain the link between dietary fat quality, LDL particles, and ASCVD (RQ3); we draw especially on RCTs in animals and humans, epidemiology, population-based changes, and experiments of nature. Additionally, the distrust over dietary recommendations for fat quality may partly relate to an unclear understanding of the scientific method, especially as applied in nutrition research, including the process of developing dietary guidelines. We therefore also aimed to clarify this process. We discuss how we assess causality in nutrition research, and how we progress from scientific evidence to providing dietary recommendations.
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Affiliation(s)
- Jacob J Christensen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Erik Kristoffer Arnesen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Amanda Rundblad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | - Ingunn Narverud
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Martin P Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Roberts WC. Quantitative Extent of Atherosclerotic Plaque in the Major Epicardial Coronary Arteries in Patients with Fatal Coronary Heart Disease, in Coronary Endarterectomy Specimens, in Aorta-Coronary Saphenous Venous Conduits, and Means to Prevent the Plaques: A Review after Studying the Coronary Arteries for 50 Years. Am J Cardiol 2018; 121:1413-1435. [PMID: 29753395 DOI: 10.1016/j.amjcard.2018.02.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
This review tries to answer the following 15 questions: Is atherosclerosis a systemic or a regional disease? Is atherosclerosis in any particular region focal or diffuse? What is the quantity of atherosclerotic plaques in endarterectomy specimens of the right coronary artery in patients undergoing coronary artery bypass grafting (CABG) compared to that in the right coronary artery in patients with fatal coronary artery disease? How do the units used for measuring arterial narrowing by angiography compare to the units used for measuring arterial narrowing at necropsy? What do atherosclerotic plaques consist of in coronary arteries in patients with fatal coronary disease? What is the quantity of atherosclerotic plaque in bypassed -vs- non-bypassed native coronary arteries in patients dying early (<60 days) or late (>60 days) after coronary artery bypass grafting? What is the frequency of acute coronary lesions and multi-luminal channels at necropsy in patients with unstable angina pectoris, sudden coronary death, and acute myocardial infarction? What is the mechanism of luminal widening by angioplasty in the coronary arteries? What observations suggest that atherosclerotic plaques are the result at least in part of organization of thrombi? Is atherosclerosis a multifactoral or a unifactoral disease? What characteristics distinguish carnivores and herbivores? What are reasonable guidelines for whom to treat with lipid-altering agents? What is the rule of 5 and the rule of 7 in statin therapy? What is the effect of lipid lowering drug therapy on coronary luminal narrowing? What are some requisites for a healthy life?
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Roberts WC. Facts and Ideas from Anywhere. Proc (Bayl Univ Med Cent) 2017; 30:384-390. [DOI: 10.1080/08998280.2017.11929658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Goyal A, Gupta T, Aronow WS, Panza JA, Cooper HA. Making the Case for Universal Treatment of Hypercholesterolemia. Am J Cardiol 2016; 118:303-4. [PMID: 27236257 DOI: 10.1016/j.amjcard.2016.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Abhishek Goyal
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Tanush Gupta
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Wilbert S Aronow
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Julio A Panza
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Howard A Cooper
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
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The evolution or revolution of statin therapy in primary prevention: where do we go from here? Curr Atheroscler Rep 2013; 15:298. [PMID: 23299639 DOI: 10.1007/s11883-012-0298-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CHD morbidity and mortality rates have more than halved since their peak in the 1960s and 1970s. This trend is a result of many factors; however, primary prevention provides the bulk of this benefit. Despite this tremendous progress, cardiovascular disease remains the major cause of death and this trend is projected to persist given the continuous growth in those aged 65 years or greater. Although statin therapy has been a main contributor to a primary prevention strategy, there is still controversy about exposing a large healthy population to long-term statin therapy. Advocates contend the mortality benefits from an aggressive statin approach would remove heart disease from its perch as the greatest killer of Americans and stroke mortality would drop from third to fifth place. Those advocating a much more conservative approach contend the data are not available to expose a healthy population to lifelong statin therapy given limited data on mortality, potential adverse events, and considerable costs. Given these opposing views, this summary of the evolution of statin therapy for the primary prevention of cardiovascular disease will review the major factors fueling this debate.
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Benjamin MM, Roberts WC. Facts and principles learned at the 39th Annual Williamsburg Conference on Heart Disease. Proc AMIA Symp 2013; 26:124-36. [PMID: 23543967 DOI: 10.1080/08998280.2013.11928935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Mina M Benjamin
- Departments of Internal Medicine (Benjamin, Roberts) and Pathology (Roberts), and the Baylor Heart and Vascular Institute (Roberts), Baylor University Medical Center at Dallas
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Abstract
This paper presents a case of reversible dysphasia occurring in a patient prescribed atorvastatin in combination with indapamide. A milder dysphasia recurred with the prescription of rosuvastatin and was documented on clinical examination. This resolved following cessation of rosuvastatin. The case highlights both a need for a wider understanding of potential drug interactions through the CYP 450 system and for an increased awareness, questioning and reporting of drug side-effects.
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Cornier MA, Marshall JA, Hill JO, Maahs DM, Eckel RH. Prevention of Overweight/Obesity as a Strategy to Optimize Cardiovascular Health. Circulation 2011; 124:840-50. [DOI: 10.1161/circulationaha.110.968461] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Marc-Andre Cornier
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
| | - Julie A. Marshall
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
| | - James O. Hill
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
| | - David M. Maahs
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
| | - Robert H. Eckel
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine (M.C., R.H.E.), Department of Epidemiology (J.A.M.), Anschutz Health and Wellness Center (J.O.H.), and Barbara Davis Center for Childhood Diabetes, The Children's Hospital Denver (D.M.M.), University of Colorado Denver, Aurora
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The Role of Atherosclerosis Imaging in Redefining Normal and Abnormal Cholesterol Values, and Risk Reduction in Primary Prevention Statin Trials. Curr Atheroscler Rep 2011; 13:422-30. [DOI: 10.1007/s11883-011-0194-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Affiliation(s)
- Barry A. Franklin
- From the Departments of Medicine and Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, MI (B.A.F.); and Departments of Medicine and Pathology, University of Vermont College of Medicine, Burlington (M.C.). Dr Franklin is Immediate Past Chair, American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Dr Cushman is Immediate Past Chair, American Heart Association Council on Epidemiology and Prevention
| | - Mary Cushman
- From the Departments of Medicine and Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, MI (B.A.F.); and Departments of Medicine and Pathology, University of Vermont College of Medicine, Burlington (M.C.). Dr Franklin is Immediate Past Chair, American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Dr Cushman is Immediate Past Chair, American Heart Association Council on Epidemiology and Prevention
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