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Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Jakobsen MU, O'Reilly EJ, Heitmann BL, Pereira MA, Bälter K, Fraser GE, Goldbourt U, Hallmans G, Knekt P, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Ascherio A. Am J Clin Nutr. 2009 Feb 11. [Epub ahead of print] PMID: 19211817 doi:10.3945/ajcn.2008.27124

What causes coronary heart disease or coronary atherosclerotic plaque, this thing that we track with heart scans? Well, here are a few little-publicized facts about heart disease that you are unlikely to hear from your When's-the-next-stent? cardiologist or the What is there besides statins? primary care doctor. (Since everybody knows that smoking is a modifiable risk for heart disease that can be readily identified, let's focus on the blood tests that reveal heart disease causes.)

A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Mente A, de Koning L, Shannon HS, Anand SS. Arch Intern Med. 2009 Apr 13;169(7):659-69. PMID: 19364995

Scientists in Canada reviewing the research so far on links between different diets and heart disease found strong evidence that diets high in vegetables and nuts, and those that follow a Mediterranean pattern rich in fruit, vegetables and fish were strongly associated with lower heart disease risk than those that rely on food with a high glycemic index or high in trans-fatty acids. High glycemic index food includes rice, pasta and refined carbohydrates like white bread, and foods high in trans-fatty acids include fried foods, baked goods and snacks.

A prospective study of egg consumption and risk of cardiovascular disease in men and women. Hu FB, Stampfer MJ, Rimm EB, Manson JE, Ascherio A, Colditz GA, Rosner BA, Spiegelman D, Speizer FE, Sacks FM, Hennekens CH, Willett WC. JAMA. 1999 Apr 21;281(15):1387-94. PMID: 10217054 CONCLUSIONS: These findings suggest that consumption of up to 1 egg per day is unlikely to have substantial overall impact on the risk of CHD or stroke among healthy men and women. The apparent increased risk of CHD associated with higher egg consumption among diabetic participants warrants further research.

June 9, 2009 -- Genetic testing confirms that high levels of a type of cholesterol known as lipoprotein(a) are associated with an increased risk for heart attacks, but the clinical implications of the finding are unclear. Lipoprotein(a) has long been suspected of contributing to cardiovascular risk. But this new research offers the strongest evidence yet identifying it as an independent risk factor for heart attack. The study appears in the June 10 issue of the Journal of the American Medical Association.

Conclusion: The associations suggest that replacing SFAs with PUFAs rather than MUFAs or carbohydrates prevents CHD over a wide range of intakes. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Jakobsen MU, O'Reilly EJ, Heitmann BL, Pereira MA, Bälter K, Fraser GE, Goldbourt U, Hallmans G, Knekt P, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Ascherio A. Am J Clin Nutr. 2009 May;89(5):1425-32. Epub 2009 Feb 11. PMID: 19211817 doi:10.3945/ajcn.2008.27124

Egg consumption and coronary heart disease: an epidemiologic overview. Kritchevsky SB, Kritchevsky D. J Am Coll Nutr. 2000 Oct;19(5 Suppl):549S-555S. Review. PMID: 11023006 When dietary confounders were considered, no association was seen between egg consumption at levels up to 1 + egg per day and the risk of coronary heart disease in non-diabetic men and women.

Egg consumption in relation to cardiovascular disease and mortality: the Physicians' Health Study. Djoussé L, Gaziano JM. Am J Clin Nutr. 2008 Apr;87(4):964-9. PMID: 18400720 Conclusions: Infrequent egg consumption does not seem to influence the risk of CVD in male physicians. In addition, egg consumption was positively related to mortality, more strongly so in diabetic subjects, in the study population.

A comparison of egg consumption with other modifiable coronary heart disease lifestyle risk factors: a relative risk apportionment study. Barraj L, Tran N, Mink P. Risk Anal. 2009 Mar;29(3):401-15. Epub 2008 Nov 4. PMID: 19000074 DOI: 10.1111/j.1539-6924.2008.01149.x Our analysis shows that the combination of modifiable lifestyle risk factors accounts for less than 40% of the population CHD mortality. For the majority of U.S. adults age 25+, consuming one egg a day accounts for <1% of CHD risk. Hence, focusing on decreasing egg intake as an approach to modify CHD risk would be expected to yield minimal results relative to changing other behaviors such as smoking and other dietary habits.

Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up. Sara Holmberg, Anders Thelin and Eva-Lena Stiernström. Int. J. Environ. Res. Public Health 2009, 6(10), 2626-2638; doi:10.3390/ijerph6102626 - published online 12 October 2009 Coronary heart disease is associated with diet. Nutritional recommendations are frequently provided, but few long term studies on the effect of food choices on heart disease are available. We followed coronary heart disease morbidity and mortality in a cohort of rural men (N = 1,752) participating in a prospective observational study. Dietary choices were assessed at baseline with a 15-item food questionnaire. 138 men were hospitalized or deceased owing to coronary heart disease during the 12 year follow-up. Daily intake of fruit and vegetables was associated with a lower risk of coronary heart disease when combined with a high dairy fat consumption (odds ratio 0.39, 95% CI 0.21-0.73), but not when combined with a low dairy fat consumption (odds ratio 1.70, 95% CI 0.97-2.98). Choosing wholemeal bread or eating fish at least twice a week showed no association with the outcome.