Bad milk, no cheese? Dairy products linked to different cardiovascular risks

Results of an observational study exploring the link between dairy product consumption and the risk of cardiovascular disease events in patients with stable disease angina suggest that different dairy products may have different health effects.

The study, which analyzed a cohort from the WENBIT trial (Western Norway B-vitamin Intervention Trial), showed that higher consumption of dairy products and milk was associated with an increased risk of mortality and stroke and butter was associated with an increased risk of acute myocardial infarction (AMI), but this cheese was associated with a reduced risk of AMI.

The results are published in the European Journal of Preventive Cardiology.

“Dairy products are a diverse food group, and different dairy products should be considered individually and not just in combination,” said lead author Vegard Lysne, MSc, of the University of Bergen Nutrition Center and Department of Heart Diseases from Haukeland University Hospital. Bergen, Norway, said | Medscape Cardiology.

Vegard Lysne

“Current dietary recommendations for dairy products are primarily based on nutrient content, with an emphasis on calcium, iodine and saturated fat,” Lysne said.

Previous studies have indicated that different dairy products can influence cardiovascular health differently, even in opposite directions, but this has primarily been studied in healthy populations, he noted.

“Data on patients with CVD is sparse, and therefore we wanted to study this in an established CVD patient population. Our main aim in this study was to explore how the consumption of different dairy products might be related to cardiovascular outcomes and mortality in such a population,” he said.

The researchers analyzed 1929 patients who had stable angina pectoris and participated in WENBIT, a prospective randomized, double-blind, placebo-controlled secondary prevention study that investigated the effect of vitamin B treatment on mortality and cardiovascular outcomes.

The majority, 80%, of the cohort were male and the average patient age was 61.8 years. In addition to stable angina pectoris, 47% of the cohort had hypertension, 31% suffered from diabetes and 29% were smokers. Most (90%) patients were taking acetylsalicylic acid, 90% were taking statins, and 77% were taking beta-blockers.

Dietary data was obtained by a food frequency questionnaire that was given to patients at their first visit and returned either by mail or at a follow-up visit 1 month after the initial visit.

The frequency of consumption was expressed in number of times per day, week, month or never consumed. Quantity was estimated using units such as slices, pieces, etc., or household measurements.

The milk variable included high-fat, low-fat, skimmed, or unspecified milk. The cheese included brown cheese, which is a caramel-like Norwegian cheese made from whey, milk, and cream; cottage cheese; cream cheeses; cooked or processed cheeses; and boxed cheeses.

Total dairy was calculated as the sum, in grams, of milk, cheese, yogurt, cream, sour cream, ice cream and butter.

The median durations of follow-up were 5.2 years for stroke, 7.8 years for AMI and 14.1 years for mortality.

Patients who reported higher consumption of dairy products and milk had a higher risk of stroke and mortality.

Among those who reported a higher intake of total dairy products, the relative risk (RR) of stroke was 1.4 (95% CI, 1.02, 1.27).

Among those who reported higher milk consumption, the RR for stroke was 1.13 (95% CI, 1.02, 1.27).

Cardiovascular mortality also appeared to be increased in those who reported a higher consumption of total dairy products (RR, 1.06; 95% CI, 1.00, 1.12) and in those who reported a higher consumption of milk (RR, 1.07; 95% CI, 1.01, 1.13).

Similarly, all-cause mortality was higher among those reporting higher total dairy consumption (HR, 1.07; 95% CI, 1.03, 1.11) and among those reporting higher (HR, 1.06; 95% CI, 1.03 – 1.10) .

High cheese consumption was inversely associated with the risk of AMI (HR, 0.92; 95% CI, 0.83, 1.02).

Butter was associated with an increased risk of AMI (HR, 1.10; 95% CI, 0.97, 1.24), as well as all-cause mortality (HR, 1.10; 95%, 1.00 – 1.20).

Lysne stressed that the results are from an observational study and doctors shouldn’t change what they tell their patients based on the results alone.

“There is a growing literature indicating that cheese may be linked to a reduction cardiovascular riskbut whether this is a causal effect, or whether cheese is a marker of higher socioeconomic status and an overall healthier lifestyle remains unknown,” he said.

“I would like future studies to assess dairy products on an individual rather than collective basis. If the data suggests that different dairy products have distinct health effects, this should be implemented in dietary recommendations,” added Lysne.

Dairy products a heterogeneous food group

“These results are not really surprising, as we have long been hearing advice to consume low-fat milk, avoid whole milk, etc., so this study confirms what we already know,” Qi Sun, MD, ScD, associate professor in the departments of nutrition and epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, said | Medscape Cardiology.

Dr Qi Sun

“However, I would be more specific on milk, and I don’t see any data regarding the fat content of the different types of milk. Their data only shows the association for total milk. I would like to see data for the low-fat milk versus high-fat milk when it comes to heart disease,” Sun said.

“They also say in their conclusion that cheese was associated with a decreased risk of acute illness. myocardial infarctionbut as the hazard ratio shows, this is a non-significant association,” he said.

Sun agrees that dairy is a heterogeneous group of foods and it’s best to consider each type separately when it comes to heart health.

“For example, heavy cream has tons of saturated fat, butter has a lot of saturated fat. Then there’s yogurt, which also comes in regular, reduced-fat, and low-fat varieties, which is a fantastic food I would say it is very healthy and is associated with a lower risk of heart disease and diabetes so a good type of dairy Yogurt and fermented dairy products should be beneficial at least more than milk whole or butter. I think butter and whole milk are still the top dairy products to avoid to reduce the risk of cardiovascular disease,” he said.

Lysne and Sun did not disclose any relevant financial relationship.

Eur J Prev Cardiol. 2022;zwac217. Summary

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