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

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). 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. 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. 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.