Dietary Components and the Risk of Coronary Heart Disease Mortality

  • Daan Kromhout
Conference paper
Part of the NATO ASI Series book series (NSSA, volume 84)


The so-called diet-heart hypothesis has dominated research on relations between dietary components and coronary heart disease during the last 30 years. This hypothesis states that saturated fats elevate serum cholesterol levels and persons with elevated serum cholesterol levels are at high risk for coronary heart disease (Keys, 1952). The evidence available for the diet-heart hypothesis will be reviewed in this paper. Other areas of current interest are the relations between energy intake, dietary fiber, obesity, and coronary heart disease and relations between dietary minerals, blood pressure, and coronary heart disease. These relations will also be reviewed and recommendations for future research will be made.


Coronary Heart Disease Energy Intake Serum Cholesterol Dietary Fiber Clinical Nutrition 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Balogh, M., Kahn, H. A., and Medalie, J. H. Random repeat 24-hour dietary recalls. American Journal of Clinical Nutrition 24 (1971) 304–310.PubMedGoogle Scholar
  2. Belizan, J. M., Villar, J., Pineda, O., Gonzalez, A. E., Sainz, E., Garrera, G., and Sibrian, R. Reduction of blood pressure with calcium supplementation in young adults. Journal of the American Medical Association 249 (1983) 1161–1165.PubMedCrossRefGoogle Scholar
  3. Cahn, A. Growth and caloric intake of heavy and tall children. Journal of the American Dietetic Association 53 (1968) 476–480.PubMedGoogle Scholar
  4. Comstock, G. W. The epidemiologic perspective: Water hardness and cardiovascular disease. Journal of Environmental Pathology and Toxicology 4 (1980) 9–25.PubMedGoogle Scholar
  5. Dayton, S., Pearce, M. L., Hashimoto, S., Dixon, W. J., and Tomiyasu, U. A controlled clinical trial of a diet high in unsaturated fat in preventing complications of atherosclerosis. Circulation 40 (1969) suppl. II.Google Scholar
  6. Ederer, F., Leren, P., Turpeinen, O., and Frantz, L. D., Jr. Cancer among men on cholesterol lowering diets. Experience from five clinical trials. Lancet 2 (1971) 203–206.PubMedCrossRefGoogle Scholar
  7. Garcia-Palmieri, M. R., Tillotson, J., Cordero, E., Costas, R., Jr., Sorlie, P., Gordon, T., Kannel, W. B., and Colon A. A. Nutrient intake and serum lipids in urban and rural Puerto Rican men. American Journal of Clinical Nutrition 30 (1977) 2092–2100.PubMedGoogle Scholar
  8. Gleibermann, L. Blood pressure and dietary salt in human populations. Ecology of Food and Nutrition 2 (1973) 143–155.CrossRefGoogle Scholar
  9. Glueck, C. J. and Connor, W. E. Diet-coronary heart disease relationships reconoitered. American Journal of Clinical Nutrition 31 (1978) 727–737.PubMedGoogle Scholar
  10. Gordon, T., Kagan, A., Garcia-Palmieri, M., Kannel, W. B., Zukel, W. J., Tillotson, J., Sorlie, P., and Hjortland, M. Diet and its relation to coronary heart disease and death in three populations. Circulation 63 (1981) 500–515.PubMedCrossRefGoogle Scholar
  11. Grim, C. E., Luft, F. C., Miller, J. Z., Meneely, G. R., Batterbee, H. D., Hames, C. G., and Dahl, L. K. Racial differences in blood pressure in Evans County, Georgia. Journal of Chronic Diseases 33 (1980) 87–94.PubMedCrossRefGoogle Scholar
  12. Heaton, K. W. Food fibre as an obstacle to energy intake. Lancet 2 (1973) 1418–1421.PubMedCrossRefGoogle Scholar
  13. Hegsted, D. M., McGandy, R. B., Myers, M. L., and Stare, F. J. Quantitative effects of dietary fat on serum cholesterol in men. American Journal of Clinical Nutrition 17 (1965) 281–295.PubMedGoogle Scholar
  14. Hulley, S. B., Sherwin, R., Nestle, M., and Lee, P. R. Epidemiology as a guide to clinical decisions. II. Diet and coronary heart disease. Western Journal of Medicine 135 (1981) 25–33.PubMedGoogle Scholar
  15. Jacobs, D. R., Jr., Anderson, J. T., and Blackburn, H. Diet and serum cholesterol: Do zero correlations negate the relationship? American Journal of Epidemiology 110 (1979) 77–87.PubMedGoogle Scholar
  16. Johnson, M. L., Burke, B. S., and Mayer, J. Relative importance of inactivity and overeating in the energy balance of obese high school girls. American Journal of Clinical Nutrition 4 (1956) 37–44.PubMedGoogle Scholar
  17. Jones, B. R., Barrett-Connor, E., Criqui, M. H., and Holdbrook, M. J. A community study of calorie and nutrient intake in drinkers and non-drinkers of alcohol. American Journal of Clinical Nutrition 35 (1982) 135–139.PubMedGoogle Scholar
  18. Kahn, H. A., Medalie, J. H., Neufeld, H. N., Riss, E., Balogh, M., and Groen, J. J. Serum cholesterol: Its distribution and association with dietary and other variables in a survey of 10,000 men. Israel Journal of Medical Sciences 5 (1969) 1117–1127.PubMedGoogle Scholar
  19. Kannel, W. B. and Gordon, T. (Eds.) The Framingham Study: An epidemiological investigation of cardiovascular disease. Section 24: The Framingham Diet Study: Diet and the regulation of serum cholesterol. Washington: U.S. Government Printing Office, 1970.Google Scholar
  20. Kay, R. M., Sabry, A. I., and Csima, A. Multivariate analysis of diet and serum lipids in normal men. American Journal of Clinical Nutrition 33 (1980) 2566–2572.PubMedGoogle Scholar
  21. Kempner, W. Treatment of hypertensive vascular disease with rice diet. American Journal of Medicine 9 (1948) 441–493.Google Scholar
  22. Keys, A. Coronary heart disease, serum cholesterol and the diet. Acta Medica Scandinavica 207 (1980) 153–160.PubMedCrossRefGoogle Scholar
  23. Keys, A. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge, Mass.: Harvard University Press, 1980.Google Scholar
  24. Keys, A. Coronary Heart disease in seven countries. Circulation 41 (1970) (suppl).Google Scholar
  25. Keys, A. The cholesterol problem. Voeding 13 (1952) 539–555.Google Scholar
  26. Keys, A. Blood lipids in men — a brief review. Journal of the American Dietetic Association 51 (1967) 508–516.PubMedGoogle Scholar
  27. Keys, A., Anderson, J. T., and Grande, F. Serum cholesterol response to changes in the diet. IV. Particular fatty acids in the diet. Metabolism 14 (1965) 776–787.CrossRefGoogle Scholar
  28. Keys, A., Aravanis, C., Blackburn, H., Buchem, F. S. P. van, Djordjevic, B. S., Dontas, A. S., Fidanza, F., Karvonen, M. J., Kimura, N., Lekos, D., Monti, M., Puddu, V., and Taylor, H. L. Epidemiological studies related to coronary heart disease: Characteristics of men aged 40–59 in seven countries. Acta Medica Scandinavica 460 (1967) (suppl).Google Scholar
  29. Khaw, K. T. and Thorn, S. Randomised double blind cross-over trial of potassium on blood pressure in normal subjects. Lancet 2 (1982) 1127–1129.PubMedCrossRefGoogle Scholar
  30. Knox, E. G. Ischaemic-heart-disease mortality and dietary intake of calcium. Lancet 1 (1973) 1465–1467.PubMedCrossRefGoogle Scholar
  31. Kromhout, D. Energy and macronutrient intake in lean and obese middle-aged men (The Zutphen Study). American Journal of Clinical Nutrition 37 (1983a) 295–299.PubMedGoogle Scholar
  32. Kromhout, D. Changes in energy and macronutrients in 871 middle-aged men during ten years of follow-up (The Zutphen Study). American Journal of Clinical Nutrition 37 (1983b) 287–294.PubMedGoogle Scholar
  33. Kromhout, D. Body weight, diet and serum cholesterol in 871 middle-aged men during ten years of follow-up (The Zutphen Study). American Journal of Clinical Nutrition 38 (1983c) 591–598.PubMedGoogle Scholar
  34. Kromhout, D., Bosschieter, E. B., and Lezenne Coulander, C. de. Dietary fibre and 10-year mortality from coronary heart disease, cancer and all causes (The Zutphen Study). Lancet 2 (1982) 518–522.PubMedCrossRefGoogle Scholar
  35. Kromhout, D. and Lezenne Coulander, C. de. Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men (The Zutphen Study). American Journal of Epidemiology May 1984.Google Scholar
  36. Kromhout, D., Bosschieter, E. B., and Lezenne Coulander, C. de. Dietary minerals, alcohol and blood pressure (The Zutphen Study). Submitted for publication.Google Scholar
  37. Langen, C. D. de. Cholestrine-stofwisseling en rassenpathologie. Geneeskun-dig Tijdschrift voor Nederlandsch Indië 56 (1916) 1–36.Google Scholar
  38. Langford, H. G. and Watson, R. L. Electrolytes and hypertension. In Epidemiology and control of hypertension. Paul, O. (ed.), Stuttgart: Georg Thieme, 1975. Pp. 119–130.Google Scholar
  39. Lincoln, J. E. Caloric intake, obesity and physical activity. American Journal of Clinical Nutrition 25 (1972) 390–394.PubMedGoogle Scholar
  40. Liu, K., Stamler, J., Dyer, A., McKeever, J., and McKeever, P. Statistical methods to assess and minimize the role of intra-individual variability in obscuring the relationship between dietary lipids and serum cholesterol. Journal of Chronic Diseases 31 (1978) 399–418.PubMedCrossRefGoogle Scholar
  41. Long, J. M., Moore, R. B., Matts, J. P., Varco, R. L., and Buchwald, H. The POSCH Group. Program of the surgical control of the hyperlipidemias (Posch). A secondary intervention trial-4-year lipid results. In Atherosclerosis VI. Schettler, G., Gotto, A. M., Middlehoff, G., Habenicht, A. J. R. and Jurutka, K. R. (eds.). New York: Springer-Verlag, 1983. Pp. 930–935.CrossRefGoogle Scholar
  42. MacGregor, G. A., Markandu, N. D., Best, F., Elder, D., Cam, J., Sagnella, G. A., and Squires, M. Double-blind randomised crossover trial of moderate sodium restriction in essential hypertension. Lancet 1 (1982) 351–355.PubMedCrossRefGoogle Scholar
  43. MacGregor, G. A., Smith, S. J., Banks, R. A., and Sagnella, G. A. Moderate potassium supplementation in essential hypertension. Lancet 2 (1982) 567–570.PubMedCrossRefGoogle Scholar
  44. Mann, G. V. Diet-heart: End of an era. New England Journal of Medicine 297 (1977) 644–650.PubMedCrossRefGoogle Scholar
  45. Marr, J. W., Gregory, J., Meade, T. W., Alderson, M. R., and Morris, J. N. Diet, leisure activity and skinfold measurements of sedentary men. Proceedings of the Nutrition Society 29 (1970) 17A-18A.PubMedGoogle Scholar
  46. Marr, J. W. and Morris, J. N. Dietary intake and the risk of coronary heart disease in Japanese men living in Hawaii. American Journal of Clinical Nutrition 34 (1981) 1156–1157.PubMedGoogle Scholar
  47. Maxfield, E. and Konishi, F. Patterns of food intake and physical activity in obesity. Journal of the American Dietetic Association 49 (1966) 406–408.PubMedGoogle Scholar
  48. McCarron, D. A., Morris, C. D., and Cole, C. Dietary calcium in human hypertension. Science 217 (1982) 267–269.PubMedCrossRefGoogle Scholar
  49. McCarthy, M. C. Dietary and activity patterns of obese women in Trinidad. Journal of the American Dietetic Association 48 (1966) 33–37.PubMedGoogle Scholar
  50. Meneely, G. R., and Batterbee, H. D. High sodium-low potassium environment and hypertension. America Journal of Cardiology 38 (1976) 768–785.CrossRefGoogle Scholar
  51. Miettinen, M., Turpeinen, O., Karvonen, M. J., Elosuo, R., and Paavilainen, E. Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. A twelve-year clinical trial in men and women. Lancet 2 (1972) 835–838.PubMedCrossRefGoogle Scholar
  52. Morgan, T., Gillies, A., Morgan, G., Adam, W., Wilson, M., and Carney, S. Hypertension treated by salt restriction. Lancet 1 (1978) 227–230.PubMedCrossRefGoogle Scholar
  53. Morris, J. N., Marr, J. W., and Clayton, D. G. Diet and heart a postcript. British Medical Journal 2 (1977) 1307–1314.PubMedCrossRefGoogle Scholar
  54. Nichols, A. B., Ravenscroft, C., Lamphiear, D. E., and Ostrander, L. D., Jr. Independence of serum lipid levels and dietary habits. The Tecumseh Study. Journal of the American Medical Association 236 (1976) 1948–1953.PubMedCrossRefGoogle Scholar
  55. Page, I. H. “Common” salt and “benign” hypertension. Modern Medicine 41 (1973) 54–55Google Scholar
  56. Parijs, J., Joossens, J. V., Linden, L. van der, Verstreken, G., and Amery, A.K.C.P. Moderate sodium restriction and diuretics in the treatment of hypertension. American Heart Journal 85 (1973) 22–34.PubMedCrossRefGoogle Scholar
  57. Pooling Project Research Group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of the Pooling Project. Journal of Chronic Diseases 31 (1978) 201–306.CrossRefGoogle Scholar
  58. Renaud, S., Morazain, R., Godsey, F., Dumont, E., Symington, I. S., Gillanders, E. M., and O’Brien, J. R. Platelet functions in relation to diet and serum lipids in British farmers. British Heart Journal 46 (1981a) 562–570.PubMedCrossRefGoogle Scholar
  59. Renaud, S., Dumont, E., Godsey, F., McGregor, L., and Morazain, R. Effects of diet on blood clotting and platelet aggregation. Nutrition in the 1980’s: Constraints on our knowledge. New York: Alan R. Liss, Inc., 1981b. Pp. 361–381.Google Scholar
  60. Rifkind, B. M., Goor, R., and Schucker, B. Compliance and cholesterollowering in clinical trials: Efficacy of diet. Atherosclerosis VI. In Schettler, G., Gotto, A. M., Middelhoff, G., Habenicht, A. J. R., and Jurutka, K. R. (eds.). New York: Springer-Verlag, 1983. Pp. 306–310.CrossRefGoogle Scholar
  61. Rifkind, B. M. and Levy, R. I. Testing the lipid hypothesis. Clinical trials. Archives of Surgery 113 (1978) 80–83.PubMedCrossRefGoogle Scholar
  62. Schlierf, G., Arab, L., Schellenberg, B., Oster, P., Mordasini, R., Schmidt-Gayk, H., and Vogel, G. Salt and hypertension: data from the “Heidelberg Study.” American Journal of Clinical Nutrition 33 (1980) 872–875.PubMedGoogle Scholar
  63. Shekelle, R. B., MacMillan Shryock, A., Paul, O., Lepper, M., Stamler, J., Liu, S., and Raynor, W. J. Diet, serum cholesterol, and death from coronary heart disease. The Western Electric Study. New England Journal of Medicine 304 (1981) 65–70.PubMedCrossRefGoogle Scholar
  64. Simpson, F. O., Waal-Manning, H. J., Bolli, P., Phelan, E. L., and Spears, G. F. S. Relationship of blood pressure to sodium excretion in a population survey. Clinical Science and Molecular Medicine 55 (1978) 373S–375S.Google Scholar
  65. Snapper, I. Chinese lessons to western medicine. New York: Interscience, 1941.Google Scholar
  66. Stamler, J. The established relationship among diet, serum cholesterol and coronary heart disease. Acta Medica Scandinavica 207 (1980) 433–446.PubMedCrossRefGoogle Scholar
  67. Stasse-Wolthuis, M. Influence of dietary fibre on cholesterol metabolism and colonic function in healthy subjects. World Review of Nutrition and Dietetics 36 (1980) 100–140.Google Scholar
  68. Stefanik, P. A., Heald, F. P., and Mayer, J. Caloric intake in relation to energy output of obese and non-obese adolescent boys. American Journal of Clinical Nutrition 7 (1959) 55–62.PubMedGoogle Scholar
  69. Stokes, G. S. Hypertension and alcohol: Is there a link? Journal of Chronic Diseases 35 (1982) 759–762.PubMedCrossRefGoogle Scholar
  70. Stulb, S. C., McDonough, J. R., Greenberg, B. G., and Hames, C. G. The relationship of nutrient intake and exercise to serum cholesterol levels in white males in Evans County, Georgia. American Journal of Clinical Nutrition 16 (1965) 238–242.PubMedGoogle Scholar
  71. Vanltallie, T. B. Dietary fiber and obesity. American Journal of Clinical Nutrition 31 (1978) S43-S52.Google Scholar
  72. Werko, L. Diet, lipids and heart attacks. Acta Medica Scandinavica 206 (1979) 435–439.PubMedGoogle Scholar
  73. Wilkinson, P. W., Parkin, J. M., Pearlson, G., Strong, H., and Sykes, P. Energy intake and physical activity in obese children. British Medical Journal 1 (1977) 756.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1985

Authors and Affiliations

  • Daan Kromhout

There are no affiliations available

Personalised recommendations