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Introduction: Most of the recent dairy studies, including multiple meta-analyses, show either no relationship or an inverse association between total dairy intake and risk of cardiovascular diseases. Some of these studies have suggested that especially fermented rather than non-fermented dairy might provide benefits on cardiovascular health, but the data is inconclusive. Also, the average dairy intake has been modest in many study populations, which reduces the generalizability of the findings to populations with high dairy intake. Hypothesis: We assessed the hypothesis that fermented and non-fermented dairy products have distinct associations with the risk of coronary heart disease (CHD) in men from eastern Finland, a population with high intake of dairy products. Methods: A total of 1981 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study from eastern Finland, aged 42-60 years, with no CHD at baseline, were included. The consumption of foods was assessed with instructed 4-day food recording by household measures. Dairy products with fat content Results: The mean±SD intakes were 733±375 g/d for total, 187±218 g/d for fermented and 546±345 g/d for non-fermented dairy. Low-fat products comprised 87% (162±218 g/d) of the fermented and 43% (317±291 g/d) of the non-fermented dairy intake. During the mean follow-up of 20.1 years, 472 CHD events occurred. The multivariable-adjusted hazard ratio (95% CI) in the highest (>280 g) vs. the lowest (727 g) vs. the lowest ( Conclusions: Our results suggest that low-fat fermented dairy products are associated with a lower risk of CHD, whereas low-fat non-fermented dairy products are associated with a higher risk in a population with high intake of dairy products.

Introduction: The epidemiological evidence of the role of dietary saturated fatty acids (SFA) in the etiology of coronary heart disease (CHD) is inconsistent. However, the proportions of different SFAs in different foods vary, and food sources of SFA (such as dairy and meat products) have had distinct associations with risk of CHD and its risk factors. Hypothesis: We assessed the hypothesis that SFA from different food sources have distinct associations with CHD risk in men. Methods: A total of 1981 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study from eastern Finland, aged 42-60 years and free of CHD at baseline, were included. The consumption of foods was assessed with instructed 4-day food recording by household measures. Dietary intakes were adjusted for total energy using the residuals method. Multivariable-adjusted Cox regression analyses included age, examination year, body mass index, diabetes, hypertension, family history of CHD, smoking, education, leisure-time physical activity, and intakes of alcohol, energy, fiber, polyunsaturated fatty acids, and fruits, berries and vegetables. Fatal and nonfatal CHD events were ascertained from national registries, with no loss to follow-up. Results: The mean±SD total SFA intake was 49.1±10.4 g/d (18.1 E%). SFA from dairy (16.1±7.7 g/d, excluding butter), butter (16.0±11.1 g/d), plant sources (6.7±5.0 g/d), processed red meat (4.7±4.2 g/d), and unprocessed red meat (3.6±2.7 g/d) contributed most to the total intake. During the mean follow-up of 19.6 years, 458 CHD events occurred. The extreme-quartile hazard ratios (95% CIs) were 1.08 (0.79-1.47, P-trend=0.57) for the highest vs. the lowest quartile of total SFA, 0.99 (0.75-1.32, P-trend=0.93) for total dairy SFA, 1.17 (0.84-1.63, P-trend=0.45) for butter SFA, 0.96 (95% CI 0.70-1.32, P-trend=0.62) for plant SFA, 1.09 (0.82-1.44, P-trend=0.76) for processed red meat SFA, and 1.15 (0.88-1.49, P-trend=0.29) for SFA from unprocessed red meat. Only SFA from fermented dairy (mean±SD intake 4.6±4.6 g/d) was associated with the risk (hazard ratio in the highest vs. the lowest quartile 0.69, 95% CI 0.52-0.91, P-trend=0.02). The associations were not appreciably different with a shorter, 10-y follow-up (199 cases). Conclusions: Our results suggest an overall non-significant role for SFA intake in the CHD risk and little difference in the associations with SFA from various food sources. Because milk is the raw material in all dairy products, the inverse association with fermented dairy likely reflects other constituents in these products than SFA.

Introduction: Different protein sources, such as processed red meat and fish have indicated distinct associations with risk of heart failure. Whether these distinct associations are partly due to the differences in proteins themselves remains unclear. Thus, we examined the associations of proteins from different food sources with risk of heart failure in Finnish male subjects. Hypothesis: We hypothesized that proteins from different dietary sources would have distinct associations with heart failure risk. Methods: The study included 2441 men aged 42-60 y at the baseline examinations in 1984-1989 in the Kuopio Ischaemic Heart Disease Risk Factor Study. Protein intakes at baseline were assessed with 4-d dietary records. Data on incident heart failure cases were obtained from national registers. The multivariable-adjusted risk of heart failure according to protein intake was estimated by Cox proportional hazard ratios. Multivariable analyses included age, examination year, education, income, family history of ischaemic heart disease, smoking, leisure-time physical activity, and intakes of alcohol, energy, fiber, and saturated, monounsaturated, polyunsaturated and trans fatty acids. Results: During the mean follow-up time of 22.2 y, 334 incident cases of heart failure occurred. Total protein (multivariable-adjusted extreme-quartile HR 1.45, 95% CI: 1.04-2.00, P-trend 0.01), animal protein (HR 1.56, 95% CI: 1.12-2.17, P-trend 0.01) and dairy protein (HR 1.53, 95% CI: 1.11-2.11, P-trend 0.01) intakes were associated with increased risk of heart failure. Especially protein from fermented dairy products associated with higher risk (HR 1.48, 95% CI: 1.08-2.02, P-trend 0.002). Adjustment for the potential effect mediators [body mass index and diseases or medications (coronary heart disease, hypertension, type 2 diabetes, lipid-lowering or heart medications) at baseline and during the follow-up] slightly attenuated the associations, but associations of animal, dairy and fermented dairy protein remained statistically significant. Plant protein intake had no association with heart failure risk (HR 1.00, 95% CI: 0.63-1.59, P-trend 0.82). Conclusions: Our data suggest that high intake of protein, especially from animal and dairy sources, may increase the risk of heart failure.

Background— Atrial fibrillation (AF) is a common cardiac arrhythmia. Regular fish consumption has been shown to reduce the risk of AF in some but not all studies. Long-chain n-3 polyunsaturated fatty acids (PUFAs) from fish have been suggested to account for these beneficial effects. We tested this hypothesis by studying the association between the serum long-chain n-3 PUFAs eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid and risk of AF in men. Methods and Results— A total of 2174 men from the prospective population-based Kuopio Ischemic Heart Disease Risk Factor Study, 42 to 60 years old and free of AF at baseline in 1984 to 1989, were studied. During the average follow-up time of 17.7 years, 240 AF events occurred. In the Cox proportional hazards model, the multivariable-adjusted hazard ratio in the highest (>5.33%) versus the lowest (P for trend=0.07). Evaluated individually, only serum docosahexaenoic acid was associated with the risk of AF (hazard ratio in the highest versus the lowest quartile 0.62, 95% confidence interval 0.42 to 0.92, P for trend=0.02). Exclusion of subjects (n=233) with myocardial infarction or congestive heart failure either at baseline or that preceded the AF event during follow-up slightly strengthened the associations. Serum intermediate chain-length n-3 PUFA, α-linolenic acid, or hair methylmercury concentration were not associated with the risk. Conclusions— An increased concentration of long-chain n-3 PUFAs in serum, a marker of fish or fish oil consumption, may protect against AF. Serum docosahexaenoic acid concentration had the greatest impact.

Background— Self-selected supplementation of vitamin E has been associated with reduced coronary events and atherosclerotic progression, but the evidence from clinical trials is controversial. In the first 3 years of the ASAP trial, the supplementation with 136 IU of vitamin E plus 250 mg of slow-release vitamin C twice daily slowed down the progression of carotid atherosclerosis in men but not women. This article examines the 6-year effect of supplementation on common carotid artery (CCA) intima-media thickness (IMT). Methods and Results— The subjects were 520 smoking and nonsmoking men and postmenopausal women aged 45 to 69 years with serum cholesterol ≥5.0 mmol/L (193 mg/dL), 440 (84.6%) of whom completed the study. Atherosclerotic progression was assessed ultrasonographically. In covariance analysis in both sexes, supplementation reduced the main study outcome, the slope of mean CCA-IMT, by 26% (95% CI, 5 to 46, P =0.014), in men by 33% (95% CI, 4 to 62, P =0.024) and in women by 14% (not significant). In both sexes combined, the average annual increase of the mean CCA-IMT was 0.014 mm in the unsupplemented and 0.010 mm in the supplemented group (25% treatment effect, 95% CI, 2 to 49, P =0.034). In men, this treatment effect was 37% (95 CI, 4 to 69, P =0.028). The effect was larger in subjects with either low baseline plasma vitamin C levels or CCA plaques. Vitamin E had no effect on HDL cholesterol. Conclusions— These data replicate our 3-year findings confirming that the supplementation with combination of vitamin E and slow-release vitamin C slows down atherosclerotic progression in hypercholesterolemic persons.

Background: Fish consumption has been associated with reduced risk of sudden cardiac death. It has been suggested that the long-chain omega-3 fatty acids from fish are responsible for the beneficial effects of fish consumption. The QT interval on the ECG measures the duration of ventricular repolarization, and a long QT interval is one of the major risk factors for sudden cardiac death. Our goal was to study the association between the serum long-chain omega-3 fatty acids eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) and QT interval duration in middle aged men. As fish is also the major source of methylmercury, an environmental contaminant proposed to have adverse cardiovascular effects, we also evaluated the impact of methylmercury exposure on the QT duration. Methods: A total of 1411 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42–60 years and free of cardiovascular disease, were included. A standardized resting 12-lead ECG was used for recording. Men with QRS ≥120 ms were excluded. The heart rate-corrected QT interval (QTc) was calculated using the Bazett’s formula. Prolonged QTc was defined as QTc >440 ms. Quartiles of the percentage of EPA, DPA and DHA of all serum fatty acids were used as the exposure. Hair mercury in quartiles was used as a marker for methylmercury exposure. Results: The mean±SD concentrations were 4.70±1.61% for EPA+DPA+DHA, 1.69±0.92% for EPA, 0.55±0.10% for DPA and 2.46±0.74% for DHA, of all serum fatty acids. The mean QTc interval in the quartiles of serum EPA+DPA+DHA was 417, 417, 415 and 414 ms (P for trend 0.02), after adjustment for age, examination year, smoking, alcohol intake, physical activity, body mass index, education, income, diabetes, treated hypertension and arrhythmia medication. Prolonged QTc was found in 169 of the 1411 men (12%). The multivariate-adjusted odds ratio (OR) for prolonged QTc in the quartiles of EPA+DPA+DHA was 1, 0.90, 0.83 and 0.63 [95% confidence interval (CI) 0.39–1.02, P for trend 0.05]. The OR in the highest vs. the lowest quartile was 0.58 (95% CI 0.36–0.93, P for trend 0.03) for EPA, 0.68 (95% CI 0.43–1.09, P for trend 0.06) for DPA and 0.59 (95% CI 0.35–0.98, P for trend 0.04) for DHA. The mean±SD hair mercury concentration was 1.9±2.0 μg/g. Hair mercury was not associated with QTc, unadjusted or adjusted. The multivariate-adjusted OR for prolonged QTc in the quartiles of hair mercury was 1, 0.97, 0.99 and 1.04 (95% CI 0.64–1.69), P for trend 0.80. Conclusions: Increased concentration of long-chain omega-3 fatty acids in serum, a marker of fish or fish oil consumption, appears to protect against prolonged QTc in eastern Finnish middle-aged men. Methylmercury exposure is not associated with QTc in this study population.

Background —Although several prospective studies have shown that low folate intake and low circulating folate are associated with increased risk of coronary heart disease (CHD), the findings are inconsistent. Methods and Results —We studied the associations of dietary intake of folate, vitamin B 6 , and vitamin B 12 with the risk of acute coronary events in a prospective cohort study of 1980 Finnish men 42 to 60 years old examined in 1984 to 1989 in the Kuopio Ischemic Heart Disease Risk Factor Study. Nutrient intakes were assessed by 4-day food record. During an average follow-up time of 10 years, 199 acute coronary events occurred. In a Cox proportional hazards model adjusted for 21 conventional and nutritional CHD risk factors, men in the highest fifth of folate intake had a relative risk of acute coronary events of 0.45 (95% CI 0.25 to 0.81, P =0.008) compared with men in the lowest fifth. This association was stronger in nonsmokers and light alcohol users than in smokers and alcohol users. A high dietary intake of vitamin B 6 had no significant association and that of vitamin B 12 a weak association with a reduced risk of acute coronary events. Conclusions —The present work in CHD-free middle-aged men is the first prospective cohort study to observe a significant inverse association between quantitatively assessed moderate-to-high folate intakes and incidence of acute coronary events in men. Our findings provide further support in favor of a role of folate in the promotion of good cardiovascular health.