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Clinical Implications of JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) in a U.S. Population Insights From the ARIC (Atherosclerosis Risk in Communities) Study Yang EY et al. J Am Coll Cardiol, 2009; 54:2388-2395, doi:10.1016/j.jacc.2009.10.006 Conclusions: ARIC participants with elevated hs-CRP and low LDL-C had a CVD event rate of 1.57% per year over 6.9 years, similar to the CVD event rate noted in the JUPITER study placebo group (1.36% per year over 1.9 years). The association of hs-CRP ≥2.0 mg/l with increased CVD risk and mortality regardless of LDL-C provides us a simple method of using age and hs-CRP level for identifying higher risk individuals. (Atherosclerosis Risk in Communities study; NCT00005131)

"November 25, 2009 | Susan Jeffrey Naples, Italy - A new meta-analysis confirms that high salt intake is associated with increased risks of stroke and total cardiovascular disease (CVD) [1]. The pooled relative risk showed that an average difference of about 5 g of salt per day was associated with a 23% increased risk of stroke, the researchers report, and a 17% increase in CVD risk. The average habitual salt intake in most Western countries is 10 g per day, double the level currently recommended by the World Health Organization. "Given that the case-fatality rate for stroke is estimated at one in three, and that for total cardiovascular disease at one in five, a 23% reduction in the rate of stroke and a 17% overall reduction in the rate of cardiovascular disease attributable to a reduction in population salt intake could avert some one and a quarter million deaths from stroke, and almost three million deaths from cardiovascular disease each year," the researchers, with lead author Dr Pasquale Strazzullo (University of Naples Medical School, Italy), conclude. Moreover, because of some imprecision in salt-intake measurements in these cohort studies, the actual effects are likely to be underestimated, they add. The study was published online November 24, 2009 in the British Medical Journal."

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 Guidelines from the American Heart Association (AHA) recommend that healthy adults limit their intake of dietary cholesterol to less than 300 mg per day. Since a large egg contains about 71% of that amount, the AHA recommends restricting egg consumption unless dietary cholesterol intakes from other sources are limited. We applied a risk apportionment approach to estimate the contribution of egg consumption and other modifiable lifestyle risk factors (e.g., smoking, poor diet, minimal exercise, and alcohol intake) to coronary heart disease (CHD) risk at the population level. Specifically, we categorized the U.S. adult population ages 25+ into distinct risk groups based on the prevalence of modifiable lifestyle risk factors and applied an apportionment model, typically used to assess risk contribution at the individual level, to estimate the contribution of egg intake to CHD risk. 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.

Cardiovascular disease risk of dietary stearic acid compared with trans, other saturated, and unsaturated fatty acids: a systematic review1,3. Hunter JE, Zhang J, Kris-Etherton PM. Am J Clin Nutr. 2009 Nov 25. [Epub ahead of print] PMID: 19939984 doi:10.3945/ajcn.2009.27661 Conclusions: TFA intake should be reduced as much as possible because of its adverse effects on lipids and lipoproteins. The replacement of TFA with STA compared with other saturated fatty acids in foods that require solid fats beneficially affects LDL cholesterol, the primary target for CVD risk reduction; unsaturated fats are preferred for liquid fat applications. Research is needed to evaluate the effects of STA on emerging CVD risk markers such as fibrinogen and to understand the responses in different populations.

Vitamin D Status and the Risk of Cardiovascular Disease Death. Kilkkinen A, Knekt P, Aro A, Rissanen H, Marniemi J, Heliövaara M, Impivaara O, Reunanen A. Am J Epidemiol. 2009 Sep 17. [Epub ahead of print] PMID: 19762371 doi:10.1093/aje/kwp227 A low vitamin D level may be associated with higher risk of a fatal CVD event, particularly cerebrovascular death. These findings need to be replicated in other populations. To demonstrate a causal link between vitamin D and CVD, randomized controlled trials are required.

Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Am J Clin Nutr. 2010 Jan 13. [Epub ahead of print] PMID: 20071648 doi:10.3945/ajcn.2009.27725 Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

"Largest-ever meta-analysis finds CRP is unlikely to be causal for CVD December 21, 2009 | Lisa Nainggolan Cambridge, UK - In the largest and most comprehensive meta-analysis to date looking at C-reactive-protein (CRP) levels and risk of coronary heart disease (CHD) and stroke, British researchers conclude that CRP is unlikely to be a causal factor for cardiovascular disease [1]. Although CRP concentration was linearly associated with CHD, stroke, and vascular mortality, as well as nonvascular mortality, statistical adjustment for conventional cardiovascular risk factors "resulted in considerable weakening of associations," note the scientists of the Cambridge-based Emerging Risk Factors Collaboration (ERFC), who report their findings online December 21, 2009 in the Lancet. In an editorial accompanying the paper [2], Drs S Matthijs Boekholdt and John JP Kastelein (Academic Medical Center, Amsterdam, the Netherlands) say the UK authors "are to be commended for this impressive data set." Although the findings "add weight to the evidence of noncausality" for a role of CRP in the development of cardiovascular disease, "the debate can be resolved only by randomized trials with agents that specifically target CRP, and such compounds are currently under development," say the Dutch doctors. Commenting on the new meta-analysis for heartwire, Dr Paul Ridker (Brigham and Women's Hospital, Boston, MA), a long-time advocate of CRP and the lead investigator of the JUPITER trial, said: "Whether or not CRP is 'causal' for heart disease is neither the crucial issue at hand nor relevant for public health. What is crucial is getting international agreement that CRP identifies higher-risk individuals who would not otherwise qualify for a life-saving therapy, and then showing that such individuals clearly benefit from treatment. The new meta-analysis demonstrates the former, and JUPITER demonstrates the latter." "

Fish oil-derived fatty acids, docosahexaenoic acid and docosapentaenoic acid, and the risk of acute coronary events: the Kuopio ischaemic heart disease risk factor study. Rissanen T, Voutilainen S, Nyyssönen K, Lakka TA, Salonen JT. Circulation. 2000 Nov 28;102(22):2677-9. PMID: 11094031 Methods and Results-We studied this association in the Kuopio Ischaemic Heart Disease Risk Factor Study, a prospective population study in Eastern Finland. Subjects were randomly selected and included 1871 men aged 42 to 60 years who had no clinical coronary heart disease at baseline examination. A total of 194 men had a fatal or nonfatal acute coronary event during follow-up. In a Cox proportional hazards' model adjusting for other risk factors, men in the highest fifth of the proportion of serum DHA+DPA in all fatty acids had a 44% reduced risk (P=0.014) of acute coronary events compared with men in the lowest fifth. Men in the highest fifth of DHA+DPA who had a low hair content of mercury (2.0 µg/g). There was no association between proportion of eicosapentaenoic acid and the risk of acute coronary events. Conclusions-Our data provide further confirmation for the concept that fish oil-derived fatty acids reduce the risk of acute coronary events. However, a high mercury content in fish could attenuate this protective effect.

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.

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 Results We documented 866 incident cases of CHD and 258 incident cases of stroke in men during 8 years of follow-up and 939 incident cases of CHD and 563 incident cases of stroke in women during 14 years of follow-up. After adjustment for age, smoking, and other potential CHD risk factors, we found no evidence of an overall significant association between egg consumption and risk of CHD or stroke in either men or women. The relative risks (RRs) of CHD across categories of intake were less than 1 per week (1.0), 1 per week (1.06), 2 to 4 per week (1.12), 5 to 6 per week (0.90), and >=1 per day (1.08) (P for trend=.75) for men; and less than 1 per week (1.0), 1 per week (0.82), 2 to 4 per week (0.99), 5 to 6 per week (0.95), and >=1 per day (0.82) (P for trend=.95) for women. In subgroup analyses, higher egg consumption appeared to be associated with increased risk of CHD only among diabetic subjects (RR of CHD comparing more than 1 egg per day with less than 1 egg per week among diabetic men, 2.02 [95% confidence interval, 1.05-3.87; P for trend=.04], and among diabetic women, 1.49 [0.88-2.52; P for trend=.008]). 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.

High dietary methionine intake increases the risk of acute coronary events in middle-aged men. Virtanen JK, Voutilainen S, Rissanen TH, Happonen P, Mursu J, Laukkanen JA, Poulsen H, Lakka TA, Salonen JT. Nutr Metab Cardiovasc Dis. 2006 Mar;16(2):113-20. Epub 2005 Nov 2. PMID: 16487911 doi:10.1016/j.numecd.2005.05.005 Conclusions The main finding of this study is that long-term, moderately high dietary methionine intake may increase the risk of acute coronary events in middle-aged Finnish men free of prior CHD. More prospective research is needed to confirm the role of dietary methionine in the development of CVD, and whether its effects are independent of homocysteine.

Mercury, fish oils, and risk of acute coronary events and cardiovascular disease, coronary heart disease, and all-cause mortality in men in eastern Finland. Virtanen JK, Voutilainen S, Rissanen TH, Mursu J, Tuomainen TP, Korhonen MJ, Valkonen VP, Seppänen K, Laukkanen JA, Salonen JT. Arterioscler Thromb Vasc Biol. 2005 Jan;25(1):228-33. Epub 2004 Nov 11. PMID: 15539625 doi: 10.1161/01.ATV.0000150040.20950.61 Conclusions- High content of mercury in hair may be a risk factor for acute coronary events and CVD, CHD, and all-cause mortality in middle-aged eastern Finnish men. Mercury may also attenuate the protective effects of fish on cardiovascular health. Mercury may increase the risk of cardiovascular diseases. In this study, high mercury content in hair increased the risk of cardiovascular morbidity and mortality in middle-aged Finnish men and attenuated the beneficial effects of fish oils on cardiovascular health. Regular consumption of fish with high mercury content should be avoided.

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 Results: In an average follow-up of 20 y, 1550 new myocardial infarctions (MIs), 1342 incident strokes, and 5169 deaths occurred. Egg consumption was not associated with incident MI or stroke in a multivariate Cox regression. In contrast, adjusted hazard ratios (95% CI) for mortality were 1.0 (reference), 0.94 (0.87, 1.02), 1.03 (0.95, 1.11), 1.05 (0.93, 1.19), and 1.23 (1.11, 1.36) for the consumption of < 0.0001). This association was stronger among diabetic subjects, in whom the risk of death in a comparison of the highest with the lowest category of egg consumption was twofold (hazard ratio: 2.01; 95% CI: 1.26, 3.20; P for interaction = 0.09). 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.

October 17, 2006 | Steve Stiles Boston, MA - A review of the literature on the health effects of dietary fish or fish-oil intake has a reassuring message for seafood lovers, anyone eating fish for health reasons, and perhaps most everyone else [1]. Levels of mercury and other contaminants in commercially bought fish are low, and their potential risks are overwhelmed by likely reductions in cardiovascular mortality, according to a report in the October 18, 2006 issue of the Journal of the American Medical Association. "The main message is really that everybody should be eating one or two servings of fish or seafood per week for their health," Dr Dariush Mozaffarian (Harvard School of Public Health, Boston, MA) told heartwire. In his analysis, coauthored with Dr Eric B Rimm (Brigham and Women's Hospital, Boston, MA), regular "modest" intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the two long-chain n-3 polyunsaturated fatty acids (PUFAs) abundant in finfish and shellfish (collectively referred to as "fish" in the article), is associated with a 36% drop in coronary disease mortality (p Those potential benefits are immense compared with the highly publicized but apparently low health risks associated with methylmercury, dioxins, and polychlorinated biphenyls (PCBs) that have been found in some fish species, they write. The evidence suggests a potential for neurodevelopmental deficits from early exposure to methylmercury, but the risk is likely diminished by limiting intake of fish with high methylmercur

The Diet-Heart Hypothesis: Subdividing Lipoproteins Two posts ago, we made the rounds of the commonly measured blood lipids (total cholesterol, LDL, HDL, triglycerides) and how they associate with cardiac risk. It's important to keep in mind that many things associate with cardiac risk, not just blood lipids. For example, men with low serum vitamin D are at a 2.4-fold greater risk of heart attack than men with higher D levels. That alone is roughly equivalent to the predictive power of the blood lipids you get measured at the doctor's office. Coronary calcium scans (a measure of blood vessel calcification) also associate with cardiac risk better than the most commonly measured blood lipids. Lipoproteins Can be Subdivided into Several Subcategories In the continual search for better measures of cardiac risk, researchers in the 1980s decided to break down lipoprotein particles into sub-categories. One of these researchers is Dr. Ronald M. Krauss. Krauss published extensively on the association between lipoprotein size and cardiac risk, eventually concluding (source): The plasma lipoprotein profile accompanying a preponderance of small, dense LDL particles (specifically LDL-III) is associated with up to a threefold increase in the susceptibility of developing [coronary artery disease]. This has been demonstrated in case-control studies of myocardial infarction and angiographically documented coronary disease. Krauss found that small, dense LDL (sdLDL) doesn't travel alone: it typically comes along with low HDL and high triglycerides*. He called this combination of factors "lipoprotein pattern B"; its opposite is "lipoprotein pattern A": large, buoyant LDL, high HDL and low triglycerides. Incidentally, low HDL and high triglycerides are hallmarks of the metabolic syndrome, the quintessential modern metabolic disorder. Krauss and his colleagues went on to hypothesize that sdLDL promotes atherosclerosis because of its ability to penetrate the artery wall more easily

The results suggest that a short-term ketogenic diet does not have a deleterious effect on CVD risk profile and may improve the lipid disorders characteristic of atherogenic dyslipidemia. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. Sharman MJ, Kraemer WJ, Love DM, Avery NG, Gómez AL, Scheett TP, Volek JS. J Nutr. 2002 Jul;132(7):1879-85. PMID: 12097663

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.

Meat intake and mortality: a prospective study of over half a million people. Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Arch Intern Med. 2009 Mar 23;169(6):562-71. PMID: 19307518 Red and processed meat intakes were associated with modest increases in total mortality, cancer mortality, and cardiovascular disease mortality. When comparing the highest with the lowest quintile of white meat intake, there was an inverse association for total mortality and cancer mortality, as well as all other deaths for both men (Table 2) and women (Table 3). In contrast, there was a small increase in risk for CVD mortality in men with higher intake of white meat. There was no association between white meat consumption and death from injuries and sudden death in men or women.

n-3 Fatty acids and cardiovascular disease: actions and molecular mechanisms. Torrejon C, Jung UJ, Deckelbaum RJ. Prostaglandins Leukot Essent Fatty Acids. 2007 Nov-Dec;77(5-6):319-26. Epub 2007 Dec 3. Review. Erratum in: Prostaglandins Leukot Essent Fatty Acids. 2008 Feb;78(2):157. PMID: 18060753 In conclusion, a growing body of evidence, encompassing human to cellular and molecular studies are defining the roles for n-3 FA as bioactive agents for reducing the risks of and treating CVD.

"DALLAS, Jan. 8 - The same vitamin D deficiency that can result in weak bones now has been associated with an increased risk of cardiovascular disease, Framingham Heart Study researchers report in Circulation: Journal of the American Heart Association. "Vitamin D deficiency is associated with increased cardiovascular risk, above and beyond established cardiovascular risk factors," said Thomas J. Wang, M.D., assistant professor of medicine at Harvard Medical School in Boston, Mass. "The higher risk associated with vitamin D deficiency was particularly evident among individuals with high blood pressure." In a study of 1,739 offspring from Framingham Heart Study participants (average age 59, all Caucasian), researchers found that those with blood levels of vitamin D below15 nanograms per milliliter (ng/mL) had twice the risk of a cardiovascular event such as a heart attack, heart failure or stroke in the next five years compared to those with higher levels of vitamin D."