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June 29, 2026Journal of the American College of Cardiology540 citationsOpen Access

Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease

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YLYanping LiAHAdela HrubyABAdam Bernstein

Key Points

  • This study investigates how saturated fats compare with unsaturated fats and carbohydrate sources in relation to coronary heart disease (CHD) risk.
  • Followed 84,628 women from the Nurses’ Health Study and 42,908 men from the Health Professionals Follow-up Study.
  • Food frequency questionnaires were administered every 4 years to assess dietary intake.
  • Analyzed dietary fat and carbohydrate consumption over 24 to 30 years of follow-up.
  • Higher intakes of polyunsaturated fatty acids (HR 0.80, 95% CI 0.73 to 0.88, p trend <0.0001) and whole grain carbohydrates (HR 0.90, 95% CI 0.83 to 0.98, p trend = 0.003) are linked to reduced CHD risk.
  • Replacing 5% of saturated fat intake with PUFAs results in a 25% lower risk of CHD (HR 0.75, 95% CI 0.67 to 0.84, p < 0.0001).
  • Refined starches/added sugars show a positive association with CHD risk (HR 1.10, 95% CI 1.00 to 1.21, p trend = 0.04).

Abstract

Background The associations between dietary saturated fat and risk of coronary heart disease (CHD) remain controversial, but few studies have compared saturated with unsaturated fats and sources of carbohydrates in relation to CHD risk. Objective This study sought to investigate associations of saturated fats as compared with unsaturated fats and different sources of carbohydrates in relation to CHD risk. Methods We followed 84,628 women (Nurses’ Health Study, 1980 to 2010), and 42,908 men (Health Professionals Follow-up Study, 1986 to 2010) who were free of diabetes, cardiovascular disease, and cancer at baseline. Diet was assessed by semiquantitative food frequency questionnaire every 4 years. Results During 24 to 30 years of follow-up, we documented 7,667 incident cases of CHD. Higher intakes of polyunsaturated fatty acids (PUFAs) and carbohydrates from whole grains were significantly associated with lower risk of CHD (hazard ratios HR (95% confidence intervals CI) comparing the highest to the lowest quintile for PUFA: 0.80 0.73 to 0.88, p trend 0.10). Conclusions Our findings indicate that unsaturated fats, especially PUFAs, and/or high-quality carbohydrates should replace dietary saturated fats to reduce CHD risk.

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Cite This Study

Li et al. (2015) studied this question.

synapsesocial.com/papers/6a41e432d8bc5ceb756acc0bhttps://doi.org/10.1016/j.jacc.2015.07.055
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