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Circulation, Vol 88, 2771-2779, Copyright © 1993 by American Heart Association
SM Artaud-Wild, SL Connor, G Sexton and WE Connor
BACKGROUND. For decades, the coronary heart disease (CHD) mortality rate
has been four or more times higher in Finland than in France despite
comparable intakes of dietary cholesterol and saturated fat. A potential
answer to this paradox is provided by this study of 40 countries and the
analyses of other nutrients in the diets besides cholesterol and saturated
fat. METHODS AND RESULTS. CHD death rates for men aged 55 to 64 years were
derived from the World Health Organization annual vital statistics. Dietary
intakes were gathered from the Food and Agriculture Organization of the
United Nations database. Forty countries at various levels of economic
development and 40 dietary variables were investigated, including a lipid
score that combined the intakes of cholesterol and saturated fat
(Cholesterol-Saturated Fat Index [CSI]). The CSI was significantly and
positively related to CHD mortality in the 40 countries. The countries with
low CSIs had low CHD death rates. Countries with high CSIs had a wide range
of CHD death rates. France, Finland, and other Western industrialized
countries had similar CSIs. After adjusting for cholesterol and saturated
fat, milk and many components of milk (butterfat, milk protein, calcium
from milk, and riboflavin) and total calcium remained positively related to
CHD mortality for all 40 countries. There were differences in the
consumption of these foods and nutrients in France and Finland. Milk and
butterfat (fat from milk, cream, cheese, and butter) consumption was higher
in Finland than in France. The consumption of plant foods, recently shown
to be protective against CHD (vegetables and vegetable oils containing
monounsaturated and polyunsaturated fatty acids), was greater in France
than in Finland. CONCLUSIONS. Over the years, France and Finland, with
similar intakes of cholesterol and saturated fat, consistently have had
very different CHD mortality rates. This paradox may be explained as
follows. Given a high intake of cholesterol and saturated fat, the country
in which people also consume more plant foods, including small amounts of
liquid vegetable oils, and more vegetables (more antioxidants) had lower
rates of CHD mortality. On the other hand, milk and butterfat were
associated with increased CHD mortality, possibly through their effects on
thrombosis as well as on atherosclerosis.
ARTICLES
Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. A paradox
Department of Medicine, Oregon Health Sciences University, Portland 97201-3098.
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