Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease
Authors: Key Timothy J. , Appleby Paul N. , Bradbury Kathryn E. , Sweeting Michael , Wood Angela , Johansson Ingegerd , Kühn Tilman , Steur Marinka , Weiderpass Elisabete , Wennberg Maria , Lund Würtz Anne Mette , Agudo Antonio , Andersson Jonas , Arriola Larraitz , Boeing Heiner , Boer Jolanda M.A. , Bonnet Fabrice , Boutron-Ruault Marie-Christine , Cross Amanda J. , Ericson Ulrika , Fagherazzi Guy , Ferrari Pietro , Gunter Marc , Huerta José María , Katzke Verena , Khaw Kay-Tee , Krogh Vittorio , La Vecchia Carlo , Matullo Giuseppe , Moreno-Iribas Conchi , Naska Androniki , Nilsson Lena Maria , Olsen Anja , Overvad Kim , Palli Domenico , Panico Salvatore , Molina-Portillo Elena , Quirós J. Ramón , Skeie Guri , Sluijs Ivonne , Sonestedt Emily , Stepien Magdalena , Tjønneland Anne , Trichopoulou Antonia , Tumino Rosario , Tzoulaki Ioanna , van der Schouw Yvonne T. , Verschuren W.M. Monique , di Angelantonio Emanuele , Langenberg Claudia , Forouhi Nita , Wareham Nick , Butterworth Adam , Riboli Elio , Danesh John 
Published: April 2019

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.