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Dietary fat intake and risk of coronary heart disease: the Strong Heart Study^1,2,3,4

¹ From the Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK (JX and ETL); Medstar Research Institute, Hyattsville, MD (SE-A, BVH, and CM); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (CL and RRF); the Indian Health Service, Aberdeen Area Office, Aberdeen, South Dakota (EMZ); and the Department of Epidemiology and Preventive Medicine, Sackler Medical Faculty, Tel Aviv University, Tel Aviv, Israel (UG)

Background: The results of previous studies on the association between dietary fat intake and coronary heart disease (CHD) incidence are inconsistent.

Objective: The aim of this study was to examine the association between dietary fat intake and CHD incidence in American Indians in the Strong Heart Study.

Design: A total of 2938 participants aged 47–79 y and free of CHD at the second examination (1993–1995) were examined and followed for CHD, nonfatal CHD, and fatal CHD events to 31 December 2002. Dietary intake was assessed by using a 24-h diet recall and was calculated as percentages of energy.

Results: Participants were followed for a mean (±SD) of 7.2 ± 2.3 y. During follow-up, 436 incident CHD cases (298 nonfatal CHD and 138 fatal CHD events) were ascertained. Participants aged 47–59 y in the highest quartile of intake of total fat, saturated fatty acids, or monounsaturated fatty acids had higher CHD mortality than did those in the lowest quartile [hazard ratio (95% CI): 3.57 (1.21, 10.49), 5.17 (1.64, 16.36), and 3.43 (1.17, 10.04), respectively] after confounders were controlled for. These associations were not observed for those aged 60–79 y.

Conclusions: Total fat, saturated fatty acid, and monounsaturated fatty acid intake were strong predictors of CHD mortality in American Indians aged 47–59 y, independent of other established CHD risk factors. It may be prudent for American Indians to reduce their fat intake early in life to reduce the risk of dying from CHD.

Key Words: Dietary fat intake • fatty acids • cholesterol • coronary heart disease • mortality • American Indians

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