Background-High consumption of trans fat has been linked to the risk of coronary heart disease (CHD). We assessed the hypothesis that higher trans fatty acid contents in erythrocytes were associated with an elevated risk of CHD in a nested case-control study among US women. Methods and Results-Blood samples were collected from 32 826 participants of the Nurses' Health Study from 1989 to 1990. During 6 years of follow-up, 166 incident cases of CHD were ascertained and matched with 327 controls.Total trans fatty acid content in erythrocytes was significantly correlated with dietary intake of trans fat (correlation coefficientϭ0.44, PϽ0.01) and was associated with increased plasma low-density lipoprotein cholesterol (P for trend ϭ0.06), decreased plasma high-density lipoprotein cholesterol concentrations (P for trend Ͻ0.01), and increased plasma low-density lipoprotein to high-density lipoprotein ratio (P for trend Ͻ0.01). After adjustment for age, smoking status, and other dietary and lifestyle cardiovascular risk factors, higher total trans fatty acid content in erythrocytes was associated with an elevated risk of CHD. The multivariable relative risks (95% confidence intervals) of CHD from the lowest to highest quartiles of total trans fatty acid content in erythrocytes were 1.0 (reference), 1.6 (0.7 to 3.6), 1.6 (0.7 to 3.4), and 3.3 (1.5 to 7.2) (P for trend Ͻ0.01). The corresponding relative risks were 1.0, 1.1, 1.3, and 3.1 (P for trend Ͻ0.01) for a total of 18:1 trans isomers and 1.0, 1.5, 2.5, and 2.8 (P for trend Ͻ0.01) for a total of 18:2 trans isomers. Conclusions-These biomarker data provide further evidence that high trans fat consumption remains a significant risk factor for CHD after adjustment for covariates. Key Words: blood cells Ⅲ coronary disease Ⅲ fatty acids Ⅲ women T rans fat, primarily found in partially hydrogenated vegetable oils, is produced by the food industry to create solid fats from liquid oils. These fats increase the shelf life of food products and enhance the stability of frying oils. Trans fat accounts for 2 to 3% of total energy intake in US populations. 1 In a meta-analysis of 8 welldesigned controlled trials, Mensink et al showed that, of all types of fatty acids, trans fatty acids had the strongest effect on raising the serum total cholesterol to high-density lipoprotein (HDL) ratio, 2 a known predictor of coronary heart disease (CHD) risk. 3 Trans fatty acids also increase lipoprotein (a) 4,5 and plasma triacylglycerol levels 6 and are associated with systemic inflammation, endothelial dysfunction, 7,8 and increased risks of type 2 diabetes, 9 all of which are previously demonstrated independent risk factors for CHD.
Clinical Perspective p 1865Several prospective cohort studies have found a positive association between trans fat intake and the risk of CHD. 10 -14 With data combined from 4 such studies, [11][12][13][14] Mozaffarian et al estimated a pooled relative risk of 1.23 (95% CI, 1.11 to 1.37) for every 2% energy from trans fat intake at baseline. 7 However, the eff...