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New Directions in Dietary Studies of Coronary Heart Disease¹

Alberto Ascherio^* and Walter C. Willett^*;,

^* Departments of Epidemiology and Nutrition, Harvard School of Public Health Boston, MA, and the Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115

For several decades the debate on diet and coronary heart disease has been dominated by the classic diet-heart hypothesis, which predicts an adverse effect of dietary saturated fat and cholesterol and a beneficial effect of polyunsaturated fat intake. However, recent research suggests that the diet-heart relationship is much more complex than previously recognized. Antioxidants, and in particular vitamin E, are emerging as potentially useful protective factors, and there is increasing evidence that hyperhomocysteinemia is a risk factor that may be modified by dietary changes. However, substantial data support the notion that the trans fatty acids contained in partially hydrogenated vegetable oils adversely affect the risk of coronary heart disease. Other questions, such as the role of selenium and iron, the ideal amount in the diet of polyunsaturated fat of the n-6 or n-3 group (including fish oil) and how the benefits of a diet high in monounsaturated fat (such as the Mediterranean diet) compare with those of diet low in total fat (such as the traditional Asian diet) remain to be settled.

KEY WORDS: • diet • coronary disease • trans fatty acids • antioxidants • homocysteine

¹ Presented at the First International Symposium on the Role of Soy in Preventing and Treating Chronic Disease, held in Mesa, AZ, February 20–23, 1994. The symposium was sponsored by Protein Technologies International, the soybean growers from Nebraska, Indiana, and Iowa and the United Soybean Board. Guest editors for this symposium were Mark Messina, 1543 Lincoln Street, Port Townsend, WA 98368, and John W. Erdman, Jr., Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801-3852.