Background Since mid-1980s, coronary heart disease (CHD) mortality rates in Sweden have more than halved, largely reflecting improvements in cardiovascular risk factors, mainly improvements in total cholesterol. However, this favourable trend in total cholesterol has recently levelled off or even increased in some ages, associated to changes in diet that is richer in saturated fats (SFs) and low in carbohydrates. The purpose of the present study was to project future CHD mortality in Sweden taking into account future trends in dietary SFs intake.
Methods The previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2025 in the Swedish population aged 25–84. Calculations were based on a) Population numbers and projections (the Swedish National Board of Health and Welfare) b) Population risk factors levels and projections c) effects of risk factor reductions (published meta-analyses and case-control studies). We assumed that the observed historical trend in CHD mortality were to continue and compared three different scenarios for future SFs intake, with and without favourable changes in other major risk factors:
- S1: Reduction in daily intake of SFs in Sweden to 10% total energy (E) assuming substitution with unsaturated fats;
- S2: Continuing current trends in SFs intake;
- S3: Increasing intake of SF (20% E, consistent with fat-rich, low carb diet)
95% CI were obtained using a probabilistic sensitivity analysis
Results If current CHD mortality trend would continue, 5,975 deaths would be observed in 2025. For S1 scenario 810 (664–955) fewer deaths would occur, resulting in 13.6% (11.9–15.0) mortality reduction. According to S2 scenario, no change in CHD mortality is expected. However if we assume no concurrent favourable changes in other risk factors, expected number of CHD deaths for S2 would be 382 (293–485), about 6.4% (5.1–7.8) increase. For S3 number expected increase in deaths would be 21 (–59–115), but if other risk factors would remain constant this number rises to 401 (334–475), which is equivalent to 6.7% (95% CI: 6.0–7.5) CHD mortality increase.
Conclusion CHD mortality can increase as a result of unfavourable trends in diets rich in SFs resulting in cholesterol increases. While favourable trends in other risk factors might reduce its impact, substituting “bad” SFS (from dairy products and meat), with “good” mono-unsaturated (such as olive oil) and poly-unsaturated fats (such as sunflower and canola) is eminently feasible. These small and achievable beneficial dietary changes would have a large effect on CHD mortality.
- Saturated Fat
- Modelling study
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