Low-fat dietary pattern and cardiovascular disease: results from the Women's Health Initiative randomized controlled trial

Ross L Prentice; Aaron K Aragaki; Linda Van Horn; Cynthia A Thomson; Shirley A A Beresford; Jennifer Robinson; Linda Snetselaar; Garnet L Anderson; JoAnn E Manson; Matthew A Allison; Jacques E Rossouw; Barbara V Howard

doi:10.3945/ajcn.117.153270

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Low-fat dietary pattern and cardiovascular disease: results from the Women's Health Initiative randomized controlled trial

Journal article

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Low-fat dietary pattern and cardiovascular disease: results from the Women's Health Initiative randomized controlled trial

Ross L Prentice, Aaron K Aragaki, Linda Van Horn, Cynthia A Thomson, Shirley A A Beresford, Jennifer Robinson, Linda Snetselaar, Garnet L Anderson, JoAnn E Manson, Matthew A Allison, …

The American journal of clinical nutrition, Vol.106(1), pp.35-43

07/2017

DOI: 10.3945/ajcn.117.153270

PMCID: PMC5486201

PMID: 28515068

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Abstract

The influence of a low-fat dietary pattern on the cardiovascular health of postmenopausal women continues to be of public health interest. This report evaluates low-fat dietary pattern influences on cardiovascular disease (CVD) incidence and mortality during the intervention and postintervention phases of the Women's Health Initiative Dietary Modification Trial. Participants comprised 48,835 postmenopausal women aged 50-79 y; 40% were randomly assigned to a low-fat dietary pattern intervention (target of 20% of energy from fat), and 60% were randomly assigned to a usual diet comparison group. The 8.3-y intervention period ended in March 2005, after which >80% of surviving participants consented to additional active follow-up through September 2010; all participants were followed for mortality through 2013. Breast and colorectal cancer were the primary trial outcomes, and coronary heart disease (CHD) and overall CVD were additional designated outcomes. Incidence rates for CHD and total CVD did not differ between the intervention and comparison groups in either the intervention or postintervention period. However, CHD HRs comparing these groups varied strongly with baseline CVD and hypertension status. Participants without prior CVD had an intervention period CHD HR of 0.70 (95% CI: 0.56, 0.87) or 1.04 (95% CI: 0.90, 1.19) if they were normotensive or hypertensive, respectively ( -interaction = 0.003). The CHD benefit among healthy normotensive women was partially offset by an increase in ischemic stroke risk. Corresponding HRs in the postintervention period were close to null. Participants with CVD at baseline (3.4%) had CHD HRs of 1.47 (95% CI: 1.12, 1.93) and 1.61 (95% CI: 1.02, 2.55) in the intervention and postintervention periods, respectively. However, various lines of evidence suggest that results in women with CVD or hypertension at baseline are confounded by postrandomization use of cholesterol-lowering medications. CVD risk in postmenopausal women appears to be sensitive to a change to a low-fat dietary pattern and, among healthy women, includes both CHD benefit and stroke risk. This trial was registered at clinicaltrials.gov as NCT00000611.

Cardiovascular Diseases - etiology

Stroke - prevention & control

Women's Health

Follow-Up Studies

Cardiovascular Diseases - prevention & control

Humans

Middle Aged

Risk Factors

Coronary Disease - etiology

Feeding Behavior

Breast Neoplasms

Incidence

Coronary Disease - prevention & control

Stroke - etiology

Dietary Fats - pharmacology

Diet, Fat-Restricted

Dietary Fats - administration & dosage

Hypertension - complications

Postmenopause

Colorectal Neoplasms

Female

Aged

Details

Title: Subtitle: Low-fat dietary pattern and cardiovascular disease: results from the Women's Health Initiative randomized controlled trial
Creators: Ross L Prentice - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; rprentic@whi.org
Aaron K Aragaki - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Linda Van Horn - Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
Cynthia A Thomson - Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
Shirley A A Beresford - Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
Jennifer Robinson - Department of Epidemiology, University of Iowa, Iowa City, IA
Linda Snetselaar - Department of Epidemiology, University of Iowa, Iowa City, IA
Garnet L Anderson - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
JoAnn E Manson - Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Matthew A Allison - Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
Jacques E Rossouw - National Heart, Lung, and Blood Institute, Bethesda, MD; and
Barbara V Howard - MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Washington, DC
Resource Type: Journal article
Publication Details: The American journal of clinical nutrition, Vol.106(1), pp.35-43
DOI: 10.3945/ajcn.117.153270
PMID: 28515068
PMCID: PMC5486201
NLM abbreviation: Am J Clin Nutr
ISSN: 1938-3207
eISSN: 1938-3207
Publisher: United States
Grant note: R01 CA210921 / NCI NIH HHS UL1 TR001409 / NCATS NIH HHS P01 CA053996 / NCI NIH HHS T32 CA009686 / NCI NIH HHS
Language: English
Date published: 07/2017
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
Record Identifier: 9983996095502771

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