Eating less saturated fat and replacing it with unsaturated fat can reduce an individual's risk of developing cardiovascular disease (CVD) as much as cholesterol-lowering statin drugs, according to guidance published this month by the American Heart Association (AHA).
The latest guidance does not represent a departure from AHA's previous recommendations, according to the Baltimore Sun. However, the guidance takes into account the latest findings on the effects diet can have on CVD risk.
The guidance is based on an analysis of new evidence—including meta-analyses of observational studies and randomized clinical trials—on the effects of dietary fat on CVD risk.
AHA said evidence shows that replacing saturated fats with unsaturated fats leads to a similar reduction in an individual's risk of developing CVD as taking a statin treatment. AHA found individuals who lowered their intake of saturated fats and replaced that intake with unsaturated fats reduced their CVD risk by about 30 percent—which is similar to the reduction produced by statins.
According to AHA, a lower intake of saturated fat—coupled with a higher intake of both monounsaturated and polyunsaturated fat—is linked to lower rates of CVD, as well as other major causes of death. AHA said replacing saturated fats with unsaturated fats lowers low-density lipoprotein (LDL) cholesterol, or so-called "bad cholesterol," which causes atherosclerosis.
AHA said, "Taking into consideration the totality of the scientific evidence," it "strongly" concludes "that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD." AHA added, "This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern," such as the:
- Dietary Approaches to Stop Hypertension (DASH) diet; or
- Mediterranean diet, as featured in the 2013 AHA/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.
Michael Miller, director of the University of Maryland Medical Center's Center for Preventive Cardiology, said AHA's new guidance "tries to put it all in perspective—the view from 10,000 feet—but sometimes food can still be controversial." Miller said the guidance could be helpful to physicians when they are advising patients. He said, "If you're good most of the time, allow yourself one unhealthy breakfast, lunch, and dinner a week. But don't go nuts and eat a 24-ounce steak."
Dana Simpler, an internal medicine physician at Mercy Medical Center, said a poor diet can have dire consequences, adding that AHA's new guidance missed an opportunity to warn people about the extent to which their food matters. Simpler said, "Simply substituting saturated fats (bacon, red meat, butter) with unsaturated fats (vegetable oils) reduces heart attacks by 30 percent, but, what about the other 70 percent that still have life-threatening heart disease?"
Seth Martin, co-director of Johns Hopkins Hospital's Advanced Lipid Disorders Center, said he "like[s] the idea of replacing something with something," because "perfection" is difficult to achieve when it comes to a healthy diet. He said he encourages patients to adopt the DASH or Mediterranean diets, which center on low-fat, plant-based, and whole-grain foods (Cohn, Baltimore Sun/Sacramento Bee, 6/25; Sacks et al., Circulation, 6/15).
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