Natural trans fat, dairy fat, partially hydrogenated oils, and cardiometabolic health: the Ludwigshafen Risk and Cardiovascular Health Study.

Abstract

This editorial refers to ‘ Trans -fatty acids and mortality in patients referred for coronary angiography: the Ludwigshafen Risk and Cardiovascular Health Study’[†][1], by M.E. Kleber et al ., on page 1072. Kleber and colleagues have investigated levels of trans -fatty acids (TFAs) in erythrocyte membranes and risk of total mortality, cardiovascular mortality, and sudden cardiac death (SCD) in a convenience cohort of German patients hospitalized for angiography.1 After multivariable adjustment, they found that higher levels of total TFAs, and specifically C16 : 1n-7t, were associated with lower risk of SCD (for C16:1n-7t, ∼37% lower risk in the top tertile, compared with the bottom). No other significant associations were identified, including for total TFAs or C16:1n-7t and total or cardiovascular mortality, or for C18:1t or C18:2t and total mortality, cardiovascular mortality, or SCD. How should these findings be interpreted, and what are their implications? In any research study—whether in vitro science, animal experiment, metabolic study, clinical trial, or observational epidemiology—the devil is in the details. Such crucial details are frequently overlooked in our modern age of compressed news, internet, and social media reporting. In this case, the first important detail is the population studied. TFA levels were not measured in a general community, but in patients with chest pain or a positive non-invasive cardiac stress test who were hospitalized for coronary angiography between 1997 and 2000 at a tertiary care centre. Accordingly, these were not generally healthy individuals: for instance, at baseline, 73% had high blood pressure, 50% were taking lipid-lowering medication, and 40% had diabetes. Such patients would often be conscious of their symptoms and health prior to hospitalization, and consequently have altered … [1]: #fn-2