Abstract
Background: Red meat consumption has been found positively associated with cardiovascular disease (CVD) incidence and mortality in the United States and some European countries, but not in Asian countries where red meat consumption is low. The association is still unknown in Hispanic American populations which have relatively low red meat consumption but are undergoing nutrition transition towards Western dietary patterns. Objective: We aimed to estimate the association between total, processed, and unprocessed red meat consumption and nonfatal acute myocardial infarction (AMI) in the Costa Rican population. We also assessed potential mediators, effect modifiers, and the association of substituting other alternative healthy foods for red meat. Design: We recruited cases (n=1785) with a first nonfatal AMI and population-based controls (n=1785) living in Costa Rica, matched for age, sex, and area of residence. Dietary intake was assessed with a validated food frequency questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariate conditional logistic regression. Results: After adjusting for non-dietary and dietary confounders, the OR and 95% CI of nonfatal AMI was 1.12 (1.00-1.24) for 1-serving/day increase of total red meat. After further mutual adjustments between processed and unprocessed red meat, the OR and 95% CI was 1.16 (1.01-1.34) for 1-serving/day increase of processed red meat, and 1.03 (0.85-1.25) for 1-serving/day increase of unprocessed red meat. The associations were slightly modified after additionally adjusting for potential mediators including cholesterol, saturated fat, heme iron, and sodium. Substituting alternative healthier foods such as nuts, legumes, dairy, whole grains, fish, and chicken without skin or fat for red meat was associated with lower risk (ORs vary between 0.52 and 0.97). Conclusions: Increased red meat consumption as a result of the nutrition transition towards Western dietary patterns might partially explain the increased CVD rates in Costa Rica and other Hispanic American countries.
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