Thread by @DBelardoMD

Another day, another article ignoring guidelines & expert consensus on nutrition and cardiovascular disease. Disappointed to see this article from @washingtonpost post deny the link between saturated fat, cholesterol, diet, heart disease and erectile dysfunction.Thread🧵

This will be a long thread, so I will provide all citations at the end 😊

Let’s start off with the fact that nutrition science is complicated. There is no “placebo” & studying nutrition has historically had various different challenges & limitations. That being said, there are certain relationships in nutrition & cardiovascular disease that are clear.

Let’s first start off with consensus statement from the European Atherosclerosis Society Consensus Panel on LDL, which found consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.

They assessed whether the association btwn LDL & ASCVD actually fulfils the criteria for causality by evaluating the totality of evidence from genetic studies, prospective epidemiologic cohort studies, Mendelian randomization studies, & randomized trials of LDL-lowering therapies

Meta-analyses of over 200 prospective cohort studies, Mendelian randomization studies, & RCTs including more than 2 million participants w/ over 20 million person-years of follow-up & over 150000 cardiovascular events have demonstrated a remarkably consistent dose-dependent

log-linear association between the absolute magnitude of exposure of the vasculature to LDL-C and the risk of ASCVD; and this effect appears to increase with increasing duration of exposure to LDL-C. Both the naturally randomized genetic studies & the

randomized intervention trials consistently demonstrate that any mechanism of lowering plasma LDL particle concentration should reduce the risk of ASCVD events proportional to the absolute reduction in LDL-C and the cumulative duration of exposure to lower LDL-C

So what do we know about diet and cardiovascular risk? Quite a lot, actually!

Let’s first start out with our AHA/ACC guidelines, which recommend eating a plant predominant diet, swapping out SFA —> PUFA, ⬇️dietary cholesterol, refined carbs, sodium, to reduce ASCVD risk

The data on saturated fat and atherogenic lipoproteins is incredibly robust.

Get ready, lots of data incoming…

Saturated Fat
-meta-analysis of 395 published, metabolic ward experiments of the effects of various dietary lipids on blood cholesterol – which clearly demonstrates how saturated fat increases LDL-c
Isocaloric increases in SFA intake were assoc w/ ⬆️ in total and LDL-c

Ronald Mensink did a regression analysis. Purpose of this was to account for the differences in in the ward trials (previous tweet)– since the SFA is replacing other things, replacing SFA w/ mufa/pufa or CHO...

His regression analysis addressed the question—what is the effect of the SFA alone on ⬆️ LDL-C versus – how much is that because of what you’re replacing it with? So the purpose of the meta regression was to have equations to control out for those factors-

and give you the predicted and observed LDL-C based on SFA intake, taking account for all those things into the equation – known as the Mensink equations.

So if you look at these dots – each one represents a trial- these were low end trials –some of them are down to 10 individuals – that’s how much little variability there is here.

Wow, look at that! The more saturated fat you eat, the higher it will raise your LDL-c (and apoB)

What about RCTs looking at hard endpoints when swapping SFA —> PUFA?
The Lyon Heart Study— an Interventional study that increased intake of legumes, bread, fruit, vegetable & margarine (vegetable based margarine rich in PUFA)

They decreased SFA intake via meat, butter, cream.

And guess what... IMPRESSIVE outcomes!
Subjects following the diet which decreased SFA, butter & red meat, and increased PUFA, fruits, vegetables & legumes, had a 50% to 70% lower risk of recurrent heart disease, even THOUGH their arm of the study had more smokers! Wild isn’t it?

So what does diet, lifestyle, erectile dysfunction, atherosclerosis, and heart disease have to do with one another? A lot actually. So we published a paper on it.

pubmed.ncbi.nlm.nih.gov/33227246/

Vasculogenic ED has been associated with the presence of traditional modifiable cardiovascular risk factors, such as HLD, HTN, as well as future atherosclerotic cardiovascular disease events, including myocardial infarction, ischemic stroke, and cardiovascular death.

Erectile dysfunction almost always precedes other manifestations of cardiovascular disease, typically developing 5 years before the development of cardiovascular events.

The scientific evidence has established that diets high in saturated fat and cholesterol are associated with increased levels of blood total- and LDL-cholesterol and, thus, with increased risk of coronary heart disease and ED.

Numerous trials have demonstrated that eating more healthful plant-based foods, which are naturally lower in saturated fat and dietary cholesterol, reduces your risk of developing both heart disease, and ED.

The bottom line: the evidence shows that diets higher in plant foods and lower in animal foods are associated with a lower risk of erectile dysfunction, cardiovascular disease mortality, and all cause mortality.

@lreiley I hope you get a chance to read this thread. Your article skipped out on the massive amount of data that has been the foundation of CV guidelines for disease prevention, and instead cited the national cattleman’s association as a resource.

Citations:

PMID: 33227246
PMID: 17997808
PMID: 30879355
PMID: 31387433
PMID: 34979217