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Saturated Fat Not the Cause of Heart Disease

Nov 1, 2013
 

It is time to bust the myth of the role of saturated fat in heart disease, argues Aseem Malhotra, interventional cardiology specialist registrar at Croydon University Hospital in London, in an Observations piece in BMJ…. 

Dr. Malhotra reports that scientific evidence shows that advice to reduce saturated fat intake "has paradoxically increased our cardiovascular risks."

And he says the UK government’s obsession with levels of total cholesterol "has led to the over-medication of millions of people with statins and has diverted our attention from the more egregious risk factor of atherogenic dyslipidemia" (an unfavorable ratio of blood fats).

Saturated fat has been demonized since the 1970s when a landmark study concluded that there was a correlation between incidence of coronary heart disease and total cholesterol, which then correlated with the percentage of calories provided by saturated fat, explains Malhotra. "But correlation is not causation," he says. Nevertheless, we were advised to "reduce fat intake to 30% of total energy and a fall in saturated fat intake to 10%."

He points out that recent studies "have not supported any significant association between saturated fat intake and risk of CVD." Instead, saturated fat has been found to be protective.

One of the earliest obesity experiments, published in the Lancet in 1956, compared groups consuming diets of 90% fat versus 90% protein versus 90% carbohydrate and revealed that the greatest weight loss was in the fat consuming group.

And more recently, a JAMA study revealed that a "low fat" diet showed the greatest decrease in energy expenditure, an unhealthy lipid pattern, and increased insulin resistance compared with a low carbohydrate and low glycemic index diet.

Malhotra also points to the US, where percentage calorie consumption from fat has declined from 40% to 30% in the past 30 years (although absolute fat consumption has remained the same), yet obesity has rocketed. One reason, he says, is that the food industry "compensated by replacing saturated fat with added sugar."

And despite the fact that in the UK, 8 million people take statins regularly, he asks why has there been no demonstrable effect on heart disease trends during this period?

Adopting a Mediterranean diet after a heart attack is almost three times as powerful in reducing mortality as taking a statin, writes Malhotra. "Doctors need to embrace prevention as well as treatment."

"The greatest improvements in morbidity and mortality have been due not to personal responsibility but rather to public health," he concludes. "It is time to bust the myth of the role of saturated in heart disease and wind back the harms of dietary advice that has contributed to obesity."

Practice Pearls:
  • Two thirds of patients diagnosis of acute MI have metabolic syndrome.
  • Statins are the second most prescribed drug in the US.
  • Mediterranean diet after a heart attack is 3x as powerful in reducing mortality as taking a statin.