Dietary fat quality and coronary heart disease prevention: A unified theory based on evolutionary, historical, global, and modern perspectives

  • Christopher E. RamsdenEmail author
  • Keturah R. Faurot
  • Pedro Carrera-Bastos
  • Loren Cordain
  • Michel De Lorgeril
  • Laurence S. Sperling

Opinion statement

A large and growing body of evidence indicates that dietary fatty acids regulate crucial metabolic processes involved in the pathogenesis of coronary heart disease (CHD). Despite this evidence, optimal dietary fatty acid intakes for CHD prevention remain unclear. Significant gaps in the modern nutrition literature and contradictions in its interpretation have precluded broad consensus. These shortcomings can be addressed through the incorporation of evolutionary, historical, and global perspectives. The objective of this review is to propose a unified theory of optimal dietary fatty acid intake for CHD prevention that integrates critical insights from evolutionary, historical, global, and modern perspectives. This broad approach may be more likely than previous methods to characterize optimal fatty acid intakes.


Coronary Heart Disease Trans Fatty Acid Coronary Heart Disease Risk Coronary Heart Disease Prevention Coronary Heart Disease Risk Reduction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References and Recommended Reading

  1. 1.
    van der Net JB, Janssens AC, Defesche JC, et al.: Usefulness of genetic polymorphisms and conventional risk factors to predict coronary heart disease in patients with familial hypercholesterolemia. Am J Cardiol 2009, 103:375–380.PubMedCrossRefGoogle Scholar
  2. 2.
    Hemminki K, Lorenzo Bermejo J, Försti A: The balance between heritable and environmental aetiology of human disease. Nat Rev Genet 2006, 7:958–965.PubMedCrossRefGoogle Scholar
  3. 3.
    Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, et al.: Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 1999, 353:1547–1557.PubMedCrossRefGoogle Scholar
  4. 4.
    Menotti A, Kromhout D, Blackburn H, et al.: Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group. Eur J Epidemiol 1999, 15:507–515.PubMedCrossRefGoogle Scholar
  5. 5.
    Porsch-Oezcueruemez M, Bilgin Y, Wollny M, et al.: Prevalence of risk factors of coronary heart disease in Turks living in Germany: The Giessen Study. Atherosclerosis 1999, 144:185–198.PubMedCrossRefGoogle Scholar
  6. 6.
    Enas EA, Garg A, Davidson MA, et al.: Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J 1996, 48:343–353.PubMedGoogle Scholar
  7. 7.
    Gadd M, Johansson SE, Sundquist J, Wandell P: Are there differences in all-cause and coronary heart disease mortality between immigrants in Sweden and in their country of birth? A follow-up study of total populations. BMC Public Health 2006, 6:102.PubMedCrossRefGoogle Scholar
  8. 8.
    Marmot MG, Syme SL: Acculturation and coronary heart disease in Japanese-Americans. Am J Epidemiol 1976, 104:225–247.PubMedGoogle Scholar
  9. 9.
    Sekikawa A, Horiuchi BY, Edmundowicz D, et al.: A “natural experiment” in cardiovascular epidemiology in the early 21st century. Heart 2003, 89:255–257.PubMedCrossRefGoogle Scholar
  10. 10.
    Sugano M, Hirahara F: Polyunsaturated fatty acids in the food chain in Japan. Am J Clin Nutr 2000, 71(1 Suppl):189S–196S.PubMedGoogle Scholar
  11. 11.
    McLaughlin J, Middaugh J, Boudreau D, et al.: Adipose tissue triglyceride fatty acids and atherosclerosis in Alaska Natives and non-Natives. Atherosclerosis 2005, 181:353–362.PubMedCrossRefGoogle Scholar
  12. 12.
    Fan WX, Parker R, Parpia B, et al.: Erythrocyte fatty acids, plasma lipids, and cardiovascular disease in rural China. Am J Clin Nutr 1990, 52:1027–1036.PubMedGoogle Scholar
  13. 13.
    de Lorgeril M, Salen P: The Mediterranean-style diet for the prevention of cardiovascular diseases. Public Health Nutr 2006, 9:118–123.PubMedGoogle Scholar
  14. 14.
    De Caterina R, Massaro M: Omega-3 fatty acids and the regulation of expression of endothelial pro-atherogenic and pro-inflammatory genes. J Membr Biol 2005, 206:103–116.PubMedCrossRefGoogle Scholar
  15. 15.
    Terano T, Shiina T, Tamura Y: Eicosapentaenoic acid suppressed the proliferation of vascular smooth muscle cells through modulation of various steps of growth signals. Lipids 1996, 31(Suppl):S301–S304.PubMedCrossRefGoogle Scholar
  16. 16.
    Dyerberg J, Bang HO: Dietary fat and thrombosis. Lancet 1978, 1:152.PubMedCrossRefGoogle Scholar
  17. 17.
    Ailhaud G, Guesnet P, Cunnane SC: An emerging risk factor for obesity: does disequilibrium of polyunsaturated fatty acid metabolism contribute to excessive adipose tissue development? Br J Nutr 2008, 100:461–470.PubMedCrossRefGoogle Scholar
  18. 18.
    Moreno JA, Lopez-Miranda J, Perez-Martinez P, et al.: A monounsaturated fatty acid-rich diet reduces macrophage uptake of plasma oxidised low-density lipoprotein in healthy young men. Br J Nutr 2008, 100:569–575.PubMedCrossRefGoogle Scholar
  19. 19.
    Galgani JE, Uauy RD, Aguirre CA, Diaz EO: Effect of the dietary fat quality on insulin sensitivity. Br J Nutr 2008, 100:471–479.PubMedCrossRefGoogle Scholar
  20. 20.
    Aarsetoy H, Brugger-Andersen T, Hetland O, et al.: Long term influence of regular intake of high dose n-3 fatty acids on CD40-ligand, pregnancy-associated plasma protein A and matrix metalloproteinase-9 following acute myocardial infarction. Thromb Haemost 2006, 95:329–336.PubMedGoogle Scholar
  21. 21.
    Leaf A, Kang JX, Xiao YF, Billman GE: Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils. Circulation 2003, 107:2646–2652.PubMedCrossRefGoogle Scholar
  22. 22.
    Cordain L, Eaton SB, Sebastian A, et al.: Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr 2005, 81:341–354.PubMedGoogle Scholar
  23. 23.
    Muskiet FA, Fokkema MR, Schaafsma A, et al.: Is docosahexaenoic acid (DHA) essential? Lessons from DHA status regulation, our ancient diet, epidemiology and randomized controlled trials. J Nutr 2004, 134:183–186.PubMedGoogle Scholar
  24. 24.
    Ghebremeskel K, Crawford MA: Nutrition and health in relation to food production and processing. Nutr Health 1994, 9:237–253.PubMedGoogle Scholar
  25. 25.
    Zhou BF, Stamler J, Dennis B, et al.: Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTER-MAP study. J Hum Hypertens 2003, 17:623–630.PubMedCrossRefGoogle Scholar
  26. 26.
    Matalas AL: Disparities within traditional Mediterranean food patterns: an historical approach of the Greek diet. Int J Food Sci Nutr 2006, 57:529–536.PubMedCrossRefGoogle Scholar
  27. 27.
    Stanhope JM, Sampson VM, Prior IA: The Tokelau Island Migrant Study: serum lipid concentration in two environments. J Chronic Dis 1981, 34:45–55.PubMedCrossRefGoogle Scholar
  28. 28.
    Lindeberg S, Nilsson-Ehle P, Terent A, et al.: Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease: the Kitava study. J Intern Med 1994, 236:331–340.PubMedCrossRefGoogle Scholar
  29. 29.
    Mann GV, Spoerry A, Gray M, Jarashow D: Atherosclerosis in the Masai. Am J Epidemiol 1972, 95:26–37.PubMedGoogle Scholar
  30. 30.
    de Lorgeril M, Salen P, Martin JL, et al.: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999, 99:779–785.PubMedGoogle Scholar
  31. 31.
    de Lorgeril M, Renaud S, Mamelle N, et al.: Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994, 343:1454–1459.PubMedCrossRefGoogle Scholar
  32. 32.
    Kagawa Y, Nishizawa M, Suzuki M, et al.: Eicosapolyenoic acids of serum lipids of Japanese islanders with low incidence of cardiovascular diseases. J Nutr Sci Vitaminol 1982, 28:441–453.PubMedGoogle Scholar
  33. 33.
    Mozaffarian D, Willett WC: Trans fatty acids and cardiovascular risk: a unique cardiometabolic imprint? Curr Atheroscler Rep 2007, 9:486–493.PubMedCrossRefGoogle Scholar
  34. 34.
    Kavanagh K, Jones KL, Sawyer J, et al.: Trans fat diet induces abdominal obesity and changes in insulin sensitivity in monkeys. Obesity 2007, 15:1675–1684.PubMedCrossRefGoogle Scholar
  35. 35.
    Craig-Schmidt MC: World-wide consumption of trans fatty acids. Atheroscler Suppl 2006, 7:1–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Allison DB, Egan SK, Barraj LM, et al.: Estimated intakes of trans fatty and other fatty acids in the US population. J Am Diet Assoc 1999, 99:166–174; quiz 175–176.PubMedCrossRefGoogle Scholar
  37. 37.
    Rizek RL, Friend B, Page L: Fat in todays food supply—level of use and sources. J Am Oil Chem Soc 1974, 51:244–250.PubMedCrossRefGoogle Scholar
  38. 38.
    Leren P: The effect of plasma cholesterol lowering diet in male survivors of myocardial infarction. A controlled clinical trial. Acta Medica Scand Suppl 1966, 466:1–92.Google Scholar
  39. 39.
    Harris WS, Mozaffarian D, Rimm E, et al.: Omega-6 fatty acids and risk for cardiovascular disease: a science advisory from the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation 2009, 119:902–907.PubMedCrossRefGoogle Scholar
  40. 40.
    Oh K, Hu FB, Manson JE, et al.: Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses’ health study. Am J Epidemiol 2005, 161:672–679.PubMedCrossRefGoogle Scholar
  41. 41.
    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.PubMedCrossRefGoogle Scholar
  42. 42.
    Grundy SM: Influence of stearic acid on cholesterol metabolism relative to other long-chain fatty acids. Am J Clin Nutr 1994, 60(6 Suppl):986S–990S.PubMedGoogle Scholar
  43. 43.
    Mensink RP, Zock PL, Kester AD, Katan MB: Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003, 77:1146–1155.PubMedGoogle Scholar
  44. 44.
    Kelly FD, Sinclair AJ, Mann NJ, et al.: A stearic acid-rich diet improves thrombogenic and atherogenic risk factor profiles in healthy males. Eur J Clin Nutr 2001, 55:88–96.PubMedCrossRefGoogle Scholar
  45. 45.
    Gifford KD: Dietary fats, eating guides, and public policy: history, critique, and recommendations. Am J Med 2002, 113(Suppl 9B):89S–106S.PubMedCrossRefGoogle Scholar
  46. 46.
    Ervin RB, Wright JD, Wang CY, Kennedy-Stephenson J: Dietary intake of fats and fatty acids for the United States population: 1999–2000. Adv Data 2004, 1–6.Google Scholar
  47. 47.
    Cordain L: Saturated fat consumption in ancestral human diets: implications for contemporary intakes. In Phytochemicals, Nutrient-Gene Interactions. Edited by Meskin MS, Bidlack WR, Randolph RK. Boca Raton: CRC Press; 2006:115–126.Google Scholar
  48. 48.
    Cordain L, Watkins BA, Florant GL, et al.: Fatty acid analysis of wild ruminant tissues: evolutionary implications for reducing diet-related chronic disease. Eur J Clin Nutr 2002, 56:181–191.PubMedCrossRefGoogle Scholar
  49. 49.
    Kromhout D, Menotti A, Bloemberg B, et al.: Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study. Prev Med 1995, 24:308–315.PubMedCrossRefGoogle Scholar
  50. 50.
    Mozaffarian D, Pischon T, Hankinson SE, et al.: Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr 2004, 79:606–612.PubMedGoogle Scholar
  51. 51.
    German JB, Dillard CJ: Saturated fats: what dietary intake? Am J Clin Nutr 2004, 80:550–559.PubMedGoogle Scholar
  52. 52.
    Smith RD, Kelly CN, Fielding BA, et al.: Long-term monounsaturated fatty acid diets reduce platelet aggregation in healthy young subjects. Br J Nutr 2003, 90:597–606.PubMedCrossRefGoogle Scholar
  53. 53.
    Cordain L, Eaton SB, Miller JB, et al.: The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic. Eur J Clin Nutr 2002, 56(Suppl 1):S42–S52.PubMedCrossRefGoogle Scholar
  54. 54.
    Dannenberger D, Nuernberg G, Scollan N, et al.: Effect of diet on the deposition of n-3 fatty acids, conjugated linoleic and C18:1trans fatty acid isomers in muscle lipids of German Holstein bulls. J Agric Food Chem 2004, 52:6607–6615.PubMedCrossRefGoogle Scholar
  55. 55.
    Lands WE, Libelt B, Morris A, et al.: Maintenance of lower proportions of (n - 6) eicosanoid precursors in phospholipids of human plasma in response to added dietary (n - 3) fatty acids. Biochim Biophys Acta 1992, 1180:147–162.PubMedGoogle Scholar
  56. 56.
    Goyens PL, Spilker ME, Zock PL, et al.: Conversion of alpha-linolenic acid in humans is influenced by the absolute amounts of alpha-linolenic acid and linoleic acid in the diet and not by their ratio. Am J Clin Nutr 2006, 84:44–53.PubMedGoogle Scholar
  57. 57.
    Li B, Birdwell C, Whelan J: Antithetic relationship of dietary arachidonic acid and eicosapentaenoic acid on eicosanoid production in vivo. J Lipid Res 1994, 35:1869–1877.PubMedGoogle Scholar
  58. 58.
    Liou YA, King DJ, Zibrik D, Innis SM: Decreasing linoleic acid with constant alpha-linolenic acid in dietary fats increases (n-3) eicosapentaenoic acid in plasma phospholipids in healthy men. J Nutr 2007, 137:945–952.PubMedGoogle Scholar
  59. 59.
    Ghosh S, Novak EM, Innis SM: Cardiac proinflammatory pathways are altered with different dietary n-6 linoleic to n-3 alpha-linolenic acid ratios in normal, fat-fed pigs. Am J Physiol 2007, 293:H2919–H2927.Google Scholar
  60. 60.
    Hibbeln JR, Nieminen LR, Blasbalg TL, et al.: Healthy intakes of n-3 and n-6 fatty acids: estimations considering worldwide diversity. Am J Clin Nutr 2006, 83(6 Suppl):1483S–1493S.PubMedGoogle Scholar
  61. 61.
    Yam D, Eliraz A, Berry EM: Diet and disease—the Israeli paradox: possible dangers of a high omega-6 polyunsaturated fatty acid diet. Isr J Med Sci 1996, 32:1134–1143.PubMedGoogle Scholar
  62. 62.
    Eaton SB, Eaton SB 3rd, Sinclair AJ, et al.: Dietary intake of long-chain polyunsaturated fatty acids during the paleolithic. World Rev Nutr Diet 1998, 83:12–23.PubMedCrossRefGoogle Scholar
  63. 63.
    Marean CW, Bar-Matthews M, Bernatchez J, et al.: Early human use of marine resources and pigment in South Africa during the Middle Pleistocene. Nature 2007, 449:905–908.PubMedCrossRefGoogle Scholar
  64. 64.
    Gerrior S, Bente L, Hiza H: Nutrient content of the US food supply, 1909–2000. In Home Economics Research Report No 56. Alexandria, VA: Center for Nutrition Policy and Promotion, US Department of Agriculture; 2004.Google Scholar
  65. 65.
    Ramsden CE, Hibbeln JR, Lands WE: Letter to the Editor re: linoleic acid and coronary heart disease. Prostaglandins Leukot. Essent. Fatty Acids (2008), by W.S. Harris. Prostaglandins Leukot Essent Fatty Acids 2009, 80:77.PubMedCrossRefGoogle Scholar
  66. 66.
    Djousse L, Pankow JS, Eckfeldt JH, et al.: Relation between dietary linolenic acid and coronary artery disease in the National Heart, Lung, and Blood Institute Family Heart Study. Am J Clin Nutr 2001, 74:612–619.PubMedGoogle Scholar
  67. 67.
    Drewnowski A: Diet image: a new perspective on the foodfrequency questionnaire. Nutr Rev 2001, 59:370–372.PubMedGoogle Scholar
  68. 68.
    Woodhill JM, Palmer AJ, Leelarthaepin B, et al.: Low fat, low cholesterol diet in secondary prevention of coronary heart disease. Adv Exp Med Biol 1978, 109:317–330.PubMedGoogle Scholar
  69. 69.
    Dayton S, Pearce ML, Goldman H, et al.: Controlled trial of a diet high in unsaturated fat for prevention of atherosclerotic complications. Lancet 1968, 2:1060–1062.PubMedCrossRefGoogle Scholar
  70. 70.
    Turpeinen O, Karvonen MJ, Pekkarinen M, et al.: Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study. Int J Epidemiol 1979, 8:99–118.PubMedCrossRefGoogle Scholar
  71. 71.
    Rose GA, Thomson WB, Williams RT: Corn oil in treatment of ischaemic heart disease. Br Med J 1965, 1:1531–1533.PubMedCrossRefGoogle Scholar
  72. 72.
    Frantz ID Jr, Dawson EA, Ashman PL, et al.: Test of effect of lipid lowering by diet on cardiovascular risk. The Minnesota Coronary Survey. Arteriosclerosis 1989, 9:129–135.PubMedGoogle Scholar
  73. 73.
    Christensen JH, Schmidt EB, Molenberg D, Toft E: Alphalinolenic acid and heart rate variability in women examined for coronary artery disease. Nutr Metab Cardiovasc Dis 2005, 15:345–351.PubMedCrossRefGoogle Scholar
  74. 74.
    Hu FB, Stampfer MJ, Manson JE, et al.: Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women. Am J Clin Nutr 1999, 69:890–897.PubMedGoogle Scholar
  75. 75.
    Torrejon C, Jung UJ, Deckelbaum RJ: n-3 Fatty acids and cardiovascular disease: actions and molecular mechanisms. Prostaglandins Leukot Essent Fatty Acids 2007, 77:319–326.PubMedCrossRefGoogle Scholar
  76. 76.
    Wada M, DeLong CJ, Hong YH, et al.: Enzymes and receptors of prostaglandin pathways with arachidonic acidderived versus eicosapentaenoic acid-derived substrates and products. J Biol Chem 2007, 282:22254–22266.PubMedCrossRefGoogle Scholar
  77. 77.
    Cunnane SC, Plourde M, Stewart K, Crawford MA: Docosahexaenoic acid and shore-based diets in hominin encephalization: a rebuttal. Am J Hum Biol 2007, 19:578–581.PubMedCrossRefGoogle Scholar
  78. 78.
    Weaver KL, Ivester P, Chilton JA, et al.: The content of favorable and unfavorable polyunsaturated fatty acids found in commonly eaten fish. J Am Diet Assoc 2008, 108:1178–1185.PubMedCrossRefGoogle Scholar
  79. 79.
    Lands WE: Diets could prevent many diseases. Lipids 2003, 38:317–321.PubMedCrossRefGoogle Scholar
  80. 80.
    Baylin A, Campos H: Arachidonic acid in adipose tissue is associated with nonfatal acute myocardial infarction in the central valley of Costa Rica. J Nutr 2004, 134:3095–3099.PubMedGoogle Scholar
  81. 81.
    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.PubMedCrossRefGoogle Scholar
  82. 82.
    Dolecek TA, Granditis G: Dietary polyunsaturated fatty acids and mortality in the Multiple Risk Factor Intervention Trial (MRFIT). World Rev Nutr Diet 1991, 66:205–216.PubMedGoogle Scholar
  83. 83.
    Iso H, Kobayashi M, Ishihara J, et al.: Intake of fish and n3 fatty acids and risk of coronary heart disease among Japanese: the Japan Public Health Center-Based (JPHC) Study Cohort I. Circulation 2006, 113:195–202.PubMedCrossRefGoogle Scholar
  84. 84.
    Harris WS: The omega-3 index as a risk factor for coronary heart disease. Am J Clin Nutr 2008, 87:1997S–2002S.PubMedGoogle Scholar
  85. 85.
    Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet 1999, 354:447–455.Google Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  • Christopher E. Ramsden
    • 1
    Email author
  • Keturah R. Faurot
  • Pedro Carrera-Bastos
  • Loren Cordain
  • Michel De Lorgeril
  • Laurence S. Sperling
  1. 1.Department of Physical Medicine and Rehabilitation, Program on Integrative MedicineUniversity of North Carolina-Chapel Hill School of MedicineChapel HillUSA

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