Changes in Dietary Fat Intake and Projections for Coronary Heart Disease Mortality in Sweden: A Simulation Study.

Lena Björck,Martin O’Flaherty,Simon Capewell,Kurt Boman,Anna Winkvist,Ingegerd Johansson,Julia Critchley,Maria Guzman-Castillo,Piotr Bandosz,Annika Rosengren,Martin Adiels,Tuan Van Nguyen

doi:10.1371/journal.pone.0160474

Abstract

ObjectiveIn Sweden, previous favourable trends in blood cholesterol levels have recently levelled off or even increased in some age groups since 2003, potentially reflecting changing fashions and attitudes towards dietary saturated fatty acids (SFA). We aimed to examine the potential effect of different SFA intake on future coronary heart disease (CHD) mortality in 2025.MethodsWe compared the effect on future CHD mortality of two different scenarios for fat intake a) daily SFA intake decreasing to 10 energy percent (E%), and b) daily SFA intake rising to 20 E%. We assumed that there would be moderate improvements in smoking (5%), salt intake (1g/day) and physical inactivity (5% decrease) to continue recent, positive trends.ResultsIn the baseline scenario which assumed that recent mortality declines continue, approximately 5,975 CHD deaths might occur in year 2025. Anticipated improvements in smoking, dietary salt intake and physical activity, would result in some 380 (-6.4%) fewer deaths (235 in men and 145 in women). In combination with a mean SFA daily intake of 10 E%, a total of 810 (-14%) fewer deaths would occur in 2025 (535 in men and 275 in women). If the overall consumption of SFA rose to 20 E%, the expected mortality decline would be wiped out and approximately 20 (0.3%) additional deaths might occur.ConclusionCHD mortality may increase as a result of unfavourable trends in diets rich in saturated fats resulting in increases in blood cholesterol levels. These could cancel out the favourable trends in salt intake, smoking and physical activity.

Highlights

Mortality from coronary heart disease (CHD) has decreased dramatically in Sweden and other Western countries during recent decades [1]
We demonstrated that CHD mortality in the 25–84 year age group decreased by 53.4% in men and by 52.0% in women, and that 13 180 fewer deaths occurred in 2002 than would have been expected if the CHD mortality rates from 1986 had persisted [10]
Based on the IMPACT model, we concluded that approximately one third of the mortality decrease could be explained by increased use of effective medical treatments and interventions, and more than half of the decrease could be explained by populationlevel improvements in risk factors, a decrease in total blood cholesterol levels [10]

Summary

Introduction

Mortality from coronary heart disease (CHD) has decreased dramatically in Sweden and other Western countries during recent decades [1]. Based on the IMPACT model, we concluded that approximately one third of the mortality decrease could be explained by increased use of effective medical treatments and interventions, and more than half of the decrease could be explained by populationlevel improvements in risk factors, a decrease in total blood cholesterol levels (from 6.1 mmol/L to 5.5 mmol/L) [10]. Population studies in the city of Gothenburg show that total blood cholesterol levels in men have decreased from 6.5 mmol/L in 1973 [11] to 5.5 mmol/L in 2002 [10, 12] and in women from 7.4 mmol/L in 1969 [13] to 5.6 mmol/L in 2002 [12]. Data for northern Sweden are similar, with a decrease in reported total blood cholesterol from 1986 to 1992 and, after a small increase, a continued decline until 2002, followed by steady levels between 2002 and 2004 [14]

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