Advertisement

Current Atherosclerosis Reports

, Volume 12, Issue 6, pp 391–396 | Cite as

Dietary Monounsaturated Fatty Acids Appear Not to Provide Cardioprotection

  • Chiara Degirolamo
  • Lawrence L. RudelEmail author
Article

Abstract

Dietary interventions have been consistently proposed as a part of a comprehensive strategy to lower the incidence and severity of coronary heart disease (CHD), in the process providing long-term cardioprotection. Replacement of dietary saturated fatty acids (SFA) with higher intakes of monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) has been reported to be inversely associated with risk of CHD. The observed lower incidence of CHD among populations consuming a Mediterranean-type diet, mainly enriched in MUFA from olive oil, has long supported the belief that MUFA are an optimal substitution for SFA. However, both epidemiologic and interventional studies suggest that although substituting MUFA-rich foods for SFA-rich foods in the diet can potentially lower total plasma cholesterol concentrations, this substitution does not lower the extent of coronary artery atherosclerosis. In addition, although recent evidence suggests that the source of MUFA (animal fat vs vegetable oils) may differentially influence the correlation between MUFA intake and CHD mortality, animal studies suggest that neither source is cardioprotective.

Keywords

Fatty acids Dietary fat Lipoprotein metabolism Atherosclerosis Cholesterol Coronary heart disease Low-density lipoproteins High-density lipoproteins 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Mente A, de Koning L, Shannon HS, Anand SS: A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009, 169:659–669.CrossRefPubMedGoogle Scholar
  2. 2.
    Keys A: Coronary heart disease in seven countries. Circulation 1970, 41(Suppl1):1–211.Google Scholar
  3. 3.
    de Lorgeril M, Salen P: The Mediterranean diet: rationale and evidence for its benefits. Curr Atheroscl Rep 2008, 10:518–522.CrossRefGoogle Scholar
  4. 4.
    Keys A, Anderson JT, Grande F: Prediction of serum-cholesterol responses of man to changes in fats in the diets. Lancet 1957, 2:960–966.Google Scholar
  5. 5.
    Hegsted DM, McGandy RB, Myers ML, Stare FJ: Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr 1965, 17:281–295.PubMedGoogle Scholar
  6. 6.
    Mattson FH, Grundy SM: Comparison of effects of dietary saturated, monounsaturated and polyunsaturated fatty acids on plasma lipids and lipoproteins in man. J Lipid Res 1985, 26:194–202.PubMedGoogle Scholar
  7. 7.
    Grundy SM: Comparison of monounsaturated fatty acids and carbohydrates for lowering plasma cholesterol. N Engl J Med 1986, 314:745–748.CrossRefPubMedGoogle Scholar
  8. 8.
    Lloyd-Jones D, Adams RJ, Todd M, et al.: Heart Disease and Stroke Statistics 2010 Update: a report from the American Heart Association. Circulation 2010, 121:e46–e215.CrossRefPubMedGoogle Scholar
  9. 9.••
    Jakobsen MU, O’Reilly E, Heitmann BL, et al.: Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr 2009, 89:1425–1432. This large follow-up study provides powerful evidence that over a wide range of intakes, MUFA does not provide CHD prevention.CrossRefPubMedGoogle Scholar
  10. 10.••
    Warensjo E, Sundstrom J, Vessby B, et al: Markers of dietary fat quality and fatty acid desaturation as predictors of total and cardiovascular mortality: a population-based prospective study. Am J Clin Nutr 2008, 88:203–209. This study showed for the first time that when coronary mortality is assessed over a period of 30 years, serum MUFA levels are positively associated with coronary deaths.PubMedGoogle Scholar
  11. 11.
    Elmadfa I, Kornsteiner M: Dietary fat intake-a global perspective. Ann Nutr Metab 2009, 54(Suppl 1):8–14.CrossRefPubMedGoogle Scholar
  12. 12.
    USDA National Nutrient database for standard reference. Available at www.ars.usda.gov/fnic/nutrientdata. Accessed May 17, 2009.
  13. 13.
    Ros E: Dietary cis-monounsaturated fatty acids and metabolic control in type 2 diabetes. Am J Clin Nutr 2003, 78(Suppl):617S–625S.PubMedGoogle Scholar
  14. 14.
    Watts GF, Jackson P, Burke V, Lewis B: Dietary fatty acids and progression of coronary artery disease in men. Am J Clin Nutr 1996, 64:202–209.PubMedGoogle Scholar
  15. 15.
    Brouwer IA, Wanders AJ, Katan MB: Effect of animal and industrial trans fatty acids on HDL and LDL cholesterol levels in humans—a quantitative review. PLoS ONE 2010, 5:e9434.CrossRefPubMedGoogle Scholar
  16. 16.
    Truswell AS, Choudhury N: Monounsaturated oils do not all have the same effect on plasma cholesterol. Eur J Clin Nutr 1998, 52:312–315.CrossRefPubMedGoogle Scholar
  17. 17.
    Mensink RP, de Groot MJM, van den Broeke LT, et al.: Effects of monounsaturated fatty acids vs. complex carbohydrates on serum lipoproteins and apoproteins in healthy men and women. Metabolism 1989, 38:172–178.CrossRefPubMedGoogle Scholar
  18. 18.
    Visioli F, Galli C: Antiatherogenic components of olive oil. Curr Atheroscl Rep 2001, 3:64–67.CrossRefGoogle Scholar
  19. 19.
    Ramirez-Tortosa MC, Urbano G, Lopez-Jurado M, et al.: Extra-virgin olive oil increases the resistance of LDL to oxidation more than refined olive oil in free-living men with peripheral vascular disease. J Nutr 1999, 129:2177–2183.PubMedGoogle Scholar
  20. 20.
    Bos MB, de Vries JH, Feskens EJ, et al.: Effect of a high monounsaturated fatty acid diet and a Mediterranean diet on serum lipids and insulin sensitivity in adults with mild abdominal obesity. Nutr Metab Cardiovasc Dis 2009 Aug 17 [Epub ahead of print].Google Scholar
  21. 21.
    Green CD, Ozguden-Akkoc CG, Wang Y, et al.: Role of fatty acid elongases in determination of de novo synthesized monounsaturated fatty acid species. J Lipid Res 2010, 51:1871–1877.CrossRefPubMedGoogle Scholar
  22. 22.
    Nestel P, Clifton P, Noakes M: Effects of increasing dietary palmitoleic acid compared with palmitic and oleic acids on plasma lipids of hypercholesterolemic men. J Lipid Res 1994, 35:656–662.PubMedGoogle Scholar
  23. 23.
    Griel AE, Cao Y, Bagshaw DD, et al.: A macadamia nut-rich diet reduces total and LDL-cholesterol in mildly hypercholesterolemic men and women. J Nutr 2008, 138:761–767.PubMedGoogle Scholar
  24. 24.
    Garg ML, Blake RJ, Wills RB: Macadamia nut consumption lowers plasma total and LDL cholesterol levels in hypercholesterolemic men. J Nutr 2003, 133:1060–1063.PubMedGoogle Scholar
  25. 25.
    Brown JM, Shelness GS, Rudel LL: Monounsaturated fatty acids and atherosclerosis: opposing views from epidemiology and experimental animal models. Curr Atheroscler Rep 2007, 9:494–500.CrossRefPubMedGoogle Scholar
  26. 26.
    Mensink RP, Katan MB: Effects of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb 1992, 12:911–919.PubMedGoogle Scholar
  27. 27.
    Gardner CD, Kraemer HC: Monounsaturated versus polyunsaturated dietary fat and serum lipids. A meta-analysis. Arterioscler Thromb Vasc Biol 1995, 15:1917–1927.PubMedGoogle Scholar
  28. 28.
    Hu FB, Stampfer MJ, Manson JE, et al.: Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med 1997, 337:1491–1499.CrossRefPubMedGoogle Scholar
  29. 29.
    Lòpez-Miranda J, Pèrez-Jimènez F, Ros E, et al.: Olive oil and health: Summary of the II international conference on olive oil and health consensus report, Jaèn and Còrdoba (Spain) 2008. Nutr Metab Cardiovasc Dis 2010, 20:284–294.CrossRefPubMedGoogle Scholar
  30. 30.
    Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, et al.: Diet and overall survival in elderly people. BMJ 1995, 311:1457–1460.PubMedGoogle Scholar
  31. 31.
    Carr TP, Parks JS, Rudel LL: Hepatic ACAT activity in African green monkeys is highly correlated to plasma LDL cholesteryl ester enrichment and coronary artery atherosclerosis. Arterioscler Thromb 1992, 12:1274–1283.PubMedGoogle Scholar
  32. 32.
    Rudel LL, Haines J, Sawyer JK, et al.: Hepatic origin of cholesteryl oleate in coronary artery atherosclerosis in African green monkeys. Enrichment by dietary monounsaturated fat. J Clin Invest 1997, 100:74–83.CrossRefPubMedGoogle Scholar
  33. 33.
    Bell AT III, Wilson MD, Kelley KL, et al.: Monounsaturated fatty acyl-coenzyme A is predictive of atherosclerosis in human apoB-100 transgenic, LDLr -/- mice. J Lipid Res 2007, 48:1122–1131.CrossRefPubMedGoogle Scholar
  34. 34.
    Bell AT III, Kelley KL, Wilson MD, et al.: Dietary fat-induced alterations in atherosclerosis are abolished by ACAT2-deficiency in apoB100 only, LDLr-/- mice. Arterioscler Thromb Vasc Biol 2007, 27:1396–1402.CrossRefPubMedGoogle Scholar
  35. 35.••
    Degirolamo C, Shelness GS, Rudel LL: LDL cholesteryl oleate as a predictor for atherosclerosis: evidence from human and animal studies on dietary fat. J Lipid Res 2009, 50(Suppl):S434–S439. This review article provides a comprehensive analysis of the current evidence supporting the notion that plasma lipid enrichment with MUFA is predictive for atherosclerosis.CrossRefPubMedGoogle Scholar
  36. 36.
    Rudel LL, Parks JS, Sawyer JK: Compared to dietary monounsaturated and saturated fat, polyunsaturated fat protects African Green monkeys from coronary artery atherosclerosis. Arterioscler Thromb Vasc Biol 1995, 15:2101–2110.PubMedGoogle Scholar
  37. 37.
    Baylin A, Campos H: The use of fatty acid biomarkers to reflect dietary intake. Curr Opin Lipidol 2006, 17:22–27.CrossRefPubMedGoogle Scholar
  38. 38.
    Arab L: Biomarkers of fat and fatty acid intake. J Nutr 2003, 133(Suppl 3):925S–932S.PubMedGoogle Scholar
  39. 39.
    Laaksonen DE, Nyyssonen K, Niskanen L, et al.: Prediction of cardiovascular mortality in middle-aged men by dietary and serum linoleic and polyunsaturated fatty acids. Arch Intern Med 2005, 165:193–199.CrossRefPubMedGoogle Scholar
  40. 40.
    Harris WS, Poston WC, Haddock CK: Tissue n-3 and n-6 fatty acids and risk for coronary heart disease events. Atherosclerosis 2007, 193:1–10.CrossRefPubMedGoogle Scholar
  41. 41.
    Harris WS: The Omega-3 Index: from biomarker to risk marker to risk factor. Curr Atheroscler Rep 2009, 11:411–417.CrossRefPubMedGoogle Scholar
  42. 42.
    Hodson L, Skeaff CM, Fielding BA: Fatty acid composition of adipose tissue and blood in humans and its use as biomarker of dietary intake. Prog Lipid Res 2008, 47:348–380.CrossRefPubMedGoogle Scholar
  43. 43.
    Covas Mi R-GV, de la Torre R, Kafatos A, et al.: Minor components of olive oil: evidence to date of health benefits in humans. Nutr Rev 2006, 64(Suppl 1):20–30.Google Scholar
  44. 44.
    Cicero AF, Nascetti S, Lòpez-Sabater MC, et al.: Changes in LDL fatty acid composition as a response to olive oil treatment are inversely related to lipid oxidative damage: the EUROLIVE Study. J Am Coll Nutr 2008, 27:314–320.PubMedGoogle Scholar
  45. 45.
    Berglund L, Lefevre M, Ginsberg HN, et al.: Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states. Am J Clin Nutr 2007, 86:1611–1620.PubMedGoogle Scholar
  46. 46.
    Furtado JD, Campos H, Appel LJ, et al.: Effect of protein, unsaturated fat, and carbohydrate intakes on plasma apolipoprotein B and VLDL and LDL containing apolipoprotein C-III: results from the OmniHeart Trial. Am J Clin Nutr 2008, 87:1623–1630.PubMedGoogle Scholar
  47. 47.
    Tell GS, Evans GW, Folsom AR, et al.: Dietary fat intake and carotid artery wall thickness: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Epidemiol 1994, 139:979–989.PubMedGoogle Scholar
  48. 48.
    Ma J, Folsum AR, Lewis L, Eckfeldt JH.: Relation of plasma phospholipids and cholesterol ester fatty acid composition to carotid artery intima-media thickness in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 1997, 65:551–559.PubMedGoogle Scholar
  49. 49.
    Rohem E: The evidence-based Mediterranean diet reduces coronary heart disease risk, and plant-derived monounsaturated fats may reduce coronary heart disease risk. Am J Clin Nutr 2009, 90:697–698.CrossRefGoogle Scholar
  50. 50.
    Corella D, Ordovas JM: Nutrigenomics in cardiovascular medicine. Circ Cardiovasc Genet 2009, 2:637–651.CrossRefPubMedGoogle Scholar
  51. 51.
    Lefevre M, Champagne CM, Tulley RT, et al.: Individual variability in cardiovascular disease risk factor responses to low-fat and low-saturated-fat diets in men: body mass index, adiposity, and insulin resistance predict changes in LDL cholesterol. Am J Clin Nutr 2005, 82:957–963.PubMedGoogle Scholar
  52. 52.
    Reeves JB III, Weihrauch JL: Composition of Foods: Fats and Oils Raw, Processed, Prepared. Consumer and Food Economics Institute. Agriculture Handbook No. 8–4. USDA Science and Education Administration, Revised June 1979. Washington, DC: US Government Printing Office; 1979.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Translational PharmacologyConsorzio Mario Negri SudS. Maria ImbaroItaly
  2. 2.Department of Pathology, Section on Lipid SciencesWake Forest University School of MedicineWinston-SalemUSA

Personalised recommendations