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Observational Study
. 2019 Jun 18;139(25):2835-2845.
doi: 10.1161/CIRCULATIONAHA.118.038813. Epub 2019 Apr 22.

Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease

Timothy J Key  1 , Paul N Appleby  1 , Kathryn E Bradbury  1   2 , Michael Sweeting  3 , Angela Wood  3 , Ingegerd Johansson  4 , Tilman Kühn  5 , Marinka Steur  6 , Elisabete Weiderpass  7   8   9   10 , Maria Wennberg  11 , Anne Mette Lund Würtz  12 , Antonio Agudo  13 , Jonas Andersson  14 , Larraitz Arriola  15   16 , Heiner Boeing  17 , Jolanda M A Boer  18 , Fabrice Bonnet  19   20   21   22 , Marie-Christine Boutron-Ruault  19   20 , Amanda J Cross  23 , Ulrika Ericson  24 , Guy Fagherazzi  19   20 , Pietro Ferrari  25 , Marc Gunter  25 , José María Huerta  26 , Verena Katzke  5 , Kay-Tee Khaw  27 , Vittorio Krogh  28 , Carlo La Vecchia  29   30 , Giuseppe Matullo  31   32 , Conchi Moreno-Iribas  33 , Androniki Naska  34 , Lena Maria Nilsson  35 , Anja Olsen  36 , Kim Overvad  12 , Domenico Palli  37 , Salvatore Panico  38 , Elena Molina-Portillo  39 , J Ramón Quirós  40 , Guri Skeie  7 , Ivonne Sluijs  41 , Emily Sonestedt  24 , Magdalena Stepien  25 , Anne Tjønneland  36 , Antonia Trichopoulou  29   34 , Rosario Tumino  42 , Ioanna Tzoulaki  43   44   45 , Yvonne T van der Schouw  41 , W M Monique Verschuren  41 , Emanuele di Angelantonio  3 , Claudia Langenberg  6 , Nita Forouhi  6 , Nick Wareham  6 , Adam Butterworth  3 , Elio Riboli  23 , John Danesh  3
Affiliations
Observational Study

Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease

Timothy J Key et al. Circulation. .

Abstract

Background: There is uncertainty about the relevance of animal foods to the pathogenesis of ischemic heart disease (IHD). We examined meat, fish, dairy products, and eggs and risk for IHD in the pan-European EPIC cohort (European Prospective Investigation Into Cancer and Nutrition).

Methods: In this prospective study of 409 885 men and women in 9 European countries, diet was assessed with validated questionnaires and calibrated with 24-hour recalls. Lipids and blood pressure were measured in a subsample. During a mean of 12.6 years of follow-up, 7198 participants had a myocardial infarction or died of IHD. The relationships of animal foods with risk were examined with Cox regression with adjustment for other animal foods and relevant covariates.

Results: The hazard ratio (HR) for IHD was 1.19 (95% CI, 1.06-1.33) for a 100-g/d increment in intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR, 1.25 [95% CI, 1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR, 0.93 [95% CI, 0.89-0.98] per 100-g/d increment), cheese (HR, 0.92 [95% CI, 0.86-0.98] per 30-g/d increment), and eggs (HR, 0.93 [95% CI, 0.88-0.99] per 20-g/d increment); the associations with yogurt and eggs were attenuated and nonsignificant after exclusion of the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese, or eggs was associated with ≈20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-high-density lipoprotein cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-high-density lipoprotein cholesterol.

Conclusions: Risk for IHD was positively associated with consumption of red and processed meat and inversely associated with consumption of yogurt, cheese, and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non-high-density lipoprotein cholesterol and for red and processed meat with systolic blood pressure, which could mediate such effects.

Keywords: dairy products; eggs; fish; heart diseases; meat.

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Figures

Figure.
Figure.
Mutually adjusted hazard ratios (HRs; 95% CIs) for first nonfatal myocardial infarction or fatal ischemic heart disease per increment in statistically calibrated intake of animal foods. HRs are adjusted for age (continuous), smoking status and number of cigarettes per day, history of diabetes mellitus, previous hypertension, prior hyperlipidemia, Cambridge physical activity index, employment status, level of education completed, body mass (all categorical, with unknown categories added), current alcohol consumption (nondrinkers and sex-specific fifths of intake among drinkers), and calibrated intakes of energy, fruit, and vegetables combined, sugars (as percent energy), fiber from cereals, and each other food (each continuous), and stratified in the analysis by sex and EPIC (European Prospective Investigation Into Cancer and Nutrition) center. HR indicates hazard ratio; IHD, ischemic heart disease; and MI, myocardial infarction.
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