DIFFERENCES IN CORONARY MORTALITY CAN BE EXPLAINED BY DIFFERENCES IN CHOLESTEROL AND SATURATED FAT INTAKES IN 40 COUNTRIES BUT NOT IN FRANCE AND FINLAND - A PARADOX

Background. For decades, the coronary heart disease (CHD) mortality ra te has been four or more times higher in Finland than in France despit e comparable intakes of dietary cholesterol and saturated fat. A poten tial answer to this paradox is provided by this study of 40 countries and the analyses of other nutrients in the diets besides cholesterol a nd saturated fat. Methods and Results. CHD death rates for men aged 55 to 64 years were derived from the World Health Organization annual vi tal statistics. Dietary intakes were gathered from the Food and Agricu lture Organization of the United Nations database. Forty countries at various levels of economic development and 40 dietary variables were i nvestigated, including a lipid score that combined the intakes of chol esterol and saturated fat (Cholesterol-Saturated Fat Index [CSI]). The CSI was significantly and positively related to CHD mortality in the 40 countries. The countries with low CSIs had low CHD death rates. Cou ntries with high CSIs had a wide range of CHD death rates. France, Fin land, and other Western industrialized countries had similar CSIs. Aft er adjusting for cholesterol and saturated fat, milk and many componen ts of milk (butterfat, milk protein, calcium from milk, and riboflavin ) and total calcium remained positively related to CHD mortality for a ll 40 countries. There were differences in the consumption of these fo ods and nutrients in France and Finland. Milk and butterfat (fat from milk, cream, cheese, and butter) consumption was higher in Finland tha n in France. The consumption of plant foods, recently shown to be prot ective against CHD (vegetables and vegetable oils containing monounsat urated and polyunsaturated fatty acids), was greater in France than in Finland. Conclusions. Over the years, Prance and Finland, with simila r intakes of cholesterol and saturated fat, consistently have had very different CHD mortality rates. This paradox may be explained as follo ws. Given a high intake of cholesterol and saturated fat, the country in which people also consume more plant foods, including small amounts of liquid vegetable oils, and more vegetables (more antioxidants) had lower rates of CHD mortality. On the other hand, milk and butterfat w ere associated with increased CHD mortality, possibly through their ef fects on thrombosis as well as on atherosclerosis.