A study by Ascherio in 1994 demonstrated that in subjects who had suffered acute myocardial infarction (AMI), past intake of trans fatty acids, assessed from a food frequency questionnaire, was associated with increased risk. Trans fatty acid intake per day in the top quintile was 6.5 g compared with 1.7 g in the lowest quintile. After adjusting for age, energy intake, and sex, relative risk of a first AMI for the highest compared with the lowest quintile was 2.44 (95% confidence interval, 1.42-4.10). However, there was not a clear dose-response relationship.
A case-control study of sudden cardiac death found that higher concentrations of trans isomers of linoleic acid in adipose tissue, compared with lower concentrations, were associated with increased risk of sudden death. After controlling for smoking and making an allowance for social class, this relationship became insignificant.
A multicenter study in eight European countries plus Israel found that the risk of AMI was not significantly different across quartiles of the concentration of trans-18:1 fatty acids in adipose tissue, the multivariate odds ratio being 0.97 (95% confidence interval, 0.56-1.67) for the highest compared with the lowest quartiles. However, there were significant differences within countries. In Norway and Finland, relative risk was significantly increased in the highest compared with the lowest quartiles, but in Russia and Spain relative risk was significantly decreased in these groups. Exclusion from the multicenter analysis of the Spanish centers, which had particularly low intakes of trans fatty acids, resulted in a tendency to increased risk of AMI in the highest quartiles of trans-18:1 concentration. However, the trend was not statistically significant, and adjustment for confounding factors had no effect on the results.
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