Fatty acids in cardiovascular health and disease: A comprehensive update

Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Journal of Clinical Lipidology (Impact Factor: 3.9). 05/2012; 6(3):216-34. DOI: 10.1016/j.jacl.2012.04.077
Source: PubMed


Research dating back to the 1950s reported an association between the consumption of saturated fatty acids (SFAs) and risk of coronary heart disease. Recent epidemiological evidence, however, challenges these findings. It is well accepted that the consumption of SFAs increases low-density lipoprotein cholesterol (LDL-C), whereas carbohydrates, monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) do not. High-density lipoprotein (HDL)-C increases with SFA intake. Among individuals who are insulin resistant, a low-fat, high-carbohydrate diet typically has an adverse effect on lipid profiles (in addition to decreasing HDL-C, it also increases triglyceride and LDL particle concentrations). Consequently, a moderate fat diet in which unsaturated fatty acids replace SFAs and carbohydrates are not augmented is advised to lower LDL-C; compared with a low-fat diet, a moderate-fat diet will lower triglycerides and increase HDL-C. Now, there is some new evidence that is questioning the health benefits of even MUFAs and PUFAs. In addition, in a few recent studies investigators have also failed to demonstrate expected cardiovascular benefits of marine-derived omega-3 fatty acids. To clarify the clinical pros and cons of dietary fats, the National Lipid Association held a fatty acid symposium at the 2011 National Lipid Association Scientific Sessions. During these sessions, the science regarding the effects of different fatty acid classes on coronary heart disease risk was reviewed.

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    • "Research suggests that trans fatty acid intake (Hoenselaar, 2012; Mozaffarian, Aro, & Willett, 2009), diets with a high glycemic index (Jakobsen et al., 2010), and high dietary salt may be more significant risk factors for heart disease than dietary SFA (Aaron & Sanders, 2013; Mozaffarian et al., 2009). Furthermore, recent investigations suggest that increased consumption of refined carbohydrates is associated with cardiovascular risk (Baum et al., 2012; Flock, Fleming, & Kris-Etherton, 2014; Siri-Tarino et al., 2010a, 2010b). Results from a recent pooled analysis of cohort studies suggested that, when compared calorie-for-calorie, there was a significantly greater relative risk for coronary heart disease with intake of carbohydrate than SFA (Jakobsen et al., 2009). "
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    • "Oleic acid (cis-9- 18:1) and n-3 polyunsaturated FA (PUFA) together with an optimal n-6/n-3 ratio are considered to be beneficial for cardiovascular health, whereas vitamin A exhibits an important role in vision and immunity (Chávez-Servín et al., 2008; Haug et al., 2007). On the contrast, medium-chain saturated FA (SFA) (12:0, 14:0, 16:0), trans-18:1 FA and cholesterol may contribute to an increase in cardiovascular risk (Baum et al., 2012; Mozaffarian et al., 2009; Viturro et al., 2010). Furthermore, fat is the most variable component of milk, depending on intrinsic (animal species, breed, genotype, lactation stage) or extrinsic (environmental) factors (Chilliard et al., 2007). "

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