Dairy consumption and incident cardiovascular disease: a global analysis
Authors: Zhuang Pan , Liu Xiaohui , Li Yin , Ao Yang , Wu Yuqi , Ye Hao , Wan Xuzhi , Zhang Lange , Meng Denghui , Tian Yimei , Yu Xiaomei , Zhang Fan , Wang Anli , Zhang Yu , Jiao Jingjing 
Published: November 2023

BACKGROUND

The role of dairy products in the primary prevention of cardiovascular disease (CVD) remains highly debated. Our study aimed to comprehensively evaluate the association between dairy consumption and CVD risk in Eastern and Western countries.

METHODS

Cohort analyses include 487 212 individuals from the China Kadoorie Biobank (CKB) and 418 895 individuals from the UK Biobank (UKB). Dairy consumption was assessed by validated food frequency questionnaires. We calculated hazard ratios using multivariable Cox proportional-hazards models. The primary outcome was incident CVD, coronary heart disease (CHD) and stroke. An updated meta-analysis of prospective cohort studies was further conducted.

RESULTS

A total of 98 954 CVD cases occurred during a mean follow-up of 8.6 years in CKB and 11.3 years in UKB. In CKB, regular dairy consumption (mainly liquid whole milk) was not associated with CVD risk but significantly associated with a 9% (95% confidence interval [CI], 5% to 13%) higher CHD risk and a 6% (95% CI, 3% to 9%) lower stroke risk compared with non/rare consumers. In UKB, total dairy consumption was associated with lower risk of CVD, CHD and ischemic stroke. Cheese consumption was associated with lower CVD risk. Multivariable-adjusted hazard ratios (HRs) (95% CIs) comparing ≥ 7 times/week to the < 2 times/week of cheese were 0.88 (0.83–0.94) for CVD, 0.88 (0.82–0.94) for CHD, and 0.97 (0.85–1.11) for stroke. Semi-skimmed milk consumers had decreased risk of CVD and stroke. In the updated meta-analysis, total dairy consumption was significantly associated with a lower risk of CVD (relative risk [RR], 0.963; 95% CI, 0.932 to 0.995; 26 risk estimates) and stroke (RR, 0.94; 95% CI, 0.90 to 0.98; 14 risk estimates). Inverse associations with CVD incidence were found for cheese (0.94; 0.91 to 0.97; 20 risk estimates) and low-fat dairy (0.96; 0.92 to 0.99; 20 risk estimates) but not milk and yogurt.

CONCLUSIONS

Total dairy consumption is associated with a lower risk of total CVD and stroke overall but relationships vary by types of dairy products. Cheese and low-fat dairy consumption may be advocated for the primary prevention of CVD.

Clinical Perspective

What Is New?

Whether dairy products are protective for cardiovascular disease (CVD) remains highly debated.

This global largest analysis that included two original cohorts of 0.9 million participants from China and the UK and an updated meta-analysis demonstrates that higher consumption of total dairy products was associated with lower risk of CVD and stroke overall.

For dairy subtypes, cheese and low-fat dairy consumption was associated with lower CVD risk while no significant association was observed for milk, yogurt, and high-fat dairy consumption.

What Are the Clinical Implications?

Results from our two large cohort studies and updated meta-analysis support that dairy product consumption is protective for CVD, especially stroke, and provide compelling evidence relevant to dietary guidelines.

Considering specific dairy subtypes, cheese, and low-fat dairy products may be protective and should be advocated for CVD prevention.