Exploiting dietary supplementation trials to assess the impact of the prenatal environment on CVD risk

Animal studies have demonstrated that altering the maternal diet during pregnancy affects offspring disease risk. Data from human subjects on the early-life determinants of disease have been derived primarily from birth-weight associations; studies of the impact of the maternal diet are scarce and inconsistent. Investigating CVD risk factors in the offspring of women who have participated in maternal supplementation trials provides a useful resource in this research field, by virtue of employing an experimental design (as compared with observational studies). To date, follow-up studies have been published only for a small number of trials; these trials include the impact of maternal protein–energy, multiple-micronutrient and Ca supplementation on offspring disease risk. In Nepal maternal micronutrient supplementation has been shown to be associated with lower offspring systolic blood pressure at 2 years of age. Data from Guatemala on a pre- and postnatal protein–energy community intervention have suggested long-term improvements in fasting glucose and body composition but not in blood pressure. In The Gambia no association has been found between prenatal protein–energy supplementation and markers of CVD risk including body composition, blood pressure and fasting glucose and insulin in childhood and adolescence. Little evidence of an effect of maternal Ca supplementation on offspring blood pressure has been demonstrated in four trials, although the risk of high systolic blood pressure was found to be reduced in one trial. The present paper reviews the current evidence relating maternal nutritional supplementation during pregnancy to offspring CVD risk and explores the potential explanations for the lack of association.

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Quercetin reduces systolic blood pressure and plasma oxidised low-density lipoprotein concentrations in overweight subjects with a high-cardiovascular disease risk phenotype: a double-blinded, placebo-controlled cross-over study

British Journal Of Nutrition ◽

10.1017/s0007114509359127 ◽

2009 ◽

Vol 102 (7) ◽

pp. 1065-1074 ◽

Cited By ~ 290

Author(s):

Sarah Egert ◽

Anja Bosy-Westphal ◽

Jasmin Seiberl ◽

Claudia Kürbitz ◽

Uta Settler ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Plasma Concentrations ◽

Cvd Risk ◽

Entire Study ◽

Oxidised Ldl ◽

Double Blinded ◽

Overweight Subjects

Regular consumption of flavonoids may reduce the risk for CVD. However, the effects of individual flavonoids, for example, quercetin, remain unclear. The present study was undertaken to examine the effects of quercetin supplementation on blood pressure, lipid metabolism, markers of oxidative stress, inflammation, and body composition in an at-risk population of ninety-three overweight or obese subjects aged 25–65 years with metabolic syndrome traits. Subjects were randomised to receive 150 mg quercetin/d in a double-blinded, placebo-controlled cross-over trial with 6-week treatment periods separated by a 5-week washout period. Mean fasting plasma quercetin concentrations increased from 71 to 269 nmol/l (P < 0·001) during quercetin treatment. In contrast to placebo, quercetin decreased systolic blood pressure (SBP) by 2·6 mmHg (P < 0·01) in the entire study group, by 2·9 mmHg (P < 0·01) in the subgroup of hypertensive subjects and by 3·7 mmHg (P < 0·001) in the subgroup of younger adults aged 25–50 years. Quercetin decreased serum HDL-cholesterol concentrations (P < 0·001), while total cholesterol, TAG and the LDL:HDL-cholesterol and TAG:HDL-cholesterol ratios were unaltered. Quercetin significantly decreased plasma concentrations of atherogenic oxidised LDL, but did not affect TNF-α and C-reactive protein when compared with placebo. Quercetin supplementation had no effects on nutritional status. Blood parameters of liver and kidney function, haematology and serum electrolytes did not reveal any adverse effects of quercetin. In conclusion, quercetin reduced SBP and plasma oxidised LDL concentrations in overweight subjects with a high-CVD risk phenotype. Our findings provide further evidence that quercetin may provide protection against CVD.

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Omega-3 fatty acids and cardiovascular disease risk: do we understand the relationship?

Physiological Research ◽

10.33549/physiolres.931860 ◽

2009 ◽

pp. S19-S26 ◽

Cited By ~ 3

Author(s):

M Vrablík ◽

M Prusíková ◽

M Šnejdrlová ◽

L Zlatohlávek

Keyword(s):

Cardiovascular Disease ◽

Fatty Acids ◽

Disease Risk ◽

Large Body ◽

Current Evidence ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Cvd Risk ◽

Positive Effects ◽

The Impact

There is a large body of evidence documenting the effects of long-chain polyunsaturated fatty acids with the first double bond at the third position from methyl-terminal (so called omega-3 fatty acids (FAs)) on different components of cardiovascular disease (CVD) risk. However, it may seem the more answers on the topic we learn, the more questions remain to be elucidated. There are three levels of evidence documenting the impact of fish omega-3 FAs on CVD risk. Epidemiological data have shown unequivocally the increased intake of fish is associated with lower CVD morbidity and mortality. Numerous experimental studies have shown (almost always) positive effects of omega-3 FAs on lipoprotein metabolism, coagulation and platelet function, endothelial function, arterial stiffness etc. Most importantly, there are a few prospective clinical endpoint trials (DART, JELIS, GISSI Prevenzione and GISSI-HF) that have examined the impact of omega-3 FAs supplementation on cardiovascular outcomes in different patient populations. Recent meta-analyses of these and other clinical studies have yielded somewhat conflicting results. In this review we will summarize current evidence of omega-3 FAs effects on cardiovascular risk focusing on new data from recent clinical trials as well as possible practical implications for clinical practice.

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Impact of Prior Cerebrovascular Disease and Glucose Status on Incident Cerebrovascular Disease in Japanese

10.21203/rs.3.rs-665095/v1 ◽

2021 ◽

Author(s):

Momoko Oe ◽

Kazuya Fujihara ◽

Mayuko Harada Yamada ◽

Taeko Osawa ◽

Masaru Kitazawa ◽

...

Keyword(s):

Blood Pressure ◽

Glucose Tolerance ◽

Cerebrovascular Disease ◽

Systolic Blood Pressure ◽

Cox Regression ◽

Drug Prescription ◽

Cvd Risk ◽

Cox Regression Analysis ◽

The Impact ◽

Glucose Status

Abstract Background: Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. Methods: This is a retrospective cohort study including 363,627 men aged 18-72 years followed for ≥3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. Results: The subjects’ mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD+ conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR) , 8.77; 95% CI, 6.96-11.05; borderline glycemia: HR, 7.40, 95% CI, 5.97-9.17; diabetes: HR, 5.73, 95% CI, 4.52-7.25). Compared with the normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI, 1.34-1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, HDL cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD+/diabetes.Conclusions: Prior CVD had a greater impact on risk of CVD than glucose tolerance and glycemic control. In diabetes with prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategy should consider glucose tolerance status and prior CVD.

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Abstract 15670: Age-related Differences in the Contribution of Systolic Blood Pressure and Biomarkers to Cardiovascular Disease Risk Prediction: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.142.suppl_3.15670 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mahmoud Al Rifai ◽

Chiadi E Ndumele ◽

James A De Lemos ◽

Caroline Sun ◽

Ron C Hoogeveen ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Systolic Blood Pressure ◽

Risk Prediction ◽

Middle Age ◽

Disease Risk ◽

Older Individuals ◽

Prediction Equations ◽

Cvd Risk ◽

C Statistic

I ntroduction: Systolic blood pressure (SBP) is an important component of all cardiovascular disease (CVD) risk prediction equations but its biological variability and impact on estimated risk is a concern. Furthermore, predictive value of SBP may differ in older individuals where traditional risk factors (TRF) are less predictive. Hypothesis: Biomarkers reflecting hypertension-related end organ injury (hsTnT, NT-proBNP, eGFR), improve CVD risk prediction in older but not middle age adults as compared to SBP. Methods: Using data from visits 2 (1990-92) and 5 (2011-13) of ARIC, we developed 3 models- Model 1 included all TRF; Model 2- all TRF except SBP + individual biomarkers and Model 3 all TRF + individual biomarkers. C-statistics were used to assess risk discrimination for coronary heart disease, stroke, heart failure, and CVD. Results: After excluding those with prevalent CVD, there were 12,567 individuals at visit 2 (mean age 57, SD 6 years; 43% men) and 4,508 individuals at visit 5 (mean age 76, SD 5 years; 37% men). Over a median (IQR) follow-up time of 22 (12.4–26.7) years and 6.2 (5.4–6.8) years, the incidence rates of CVD events (per 1000 person-years) were 19.0 and 21.8 at visits 2 and 5, respectively. At visit 2, the model with SBP and biomarkers resulted in the largest improvement in C-statistic and SBP contributed to all models. However, at visit 5, removing SBP from the models with the biomarkers had no impact on C-statistic while the addition of the biomarkers (especially hsTnT and NT-proBNP) significantly improved C-statistics for most outcomes ( Table ). Among the biomarkers eGFR had the least additive value. Conclusions: HsTnT and NT-proBNP significantly improve risk discrimination of CHD, stroke, and HF among middle and older adults, while SBP has value in middle age but not in older age. Biomarkers should be considered in risk prediction equations in older individuals where the value of TRF such as SBP decrease.

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Abstract P206: The Risk for Cardiovascular Disease Attributable to Traditional Risk Factors Increases

Circulation ◽

10.1161/circ.137.suppl_1.p206 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Susanne Rospleszcz ◽

Barbara Thorand ◽

Tonia de las Heras Gala ◽

Christa Meisinger ◽

Rolf Holle ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Factor ◽

Systolic Blood Pressure ◽

Population Attributable Risk ◽

Temporal Trends ◽

Cvd Risk ◽

Traditional Risk Factors ◽

The Impact

Background: Cardiovascular disease (CVD) is a major cause of mortality and morbidity. Traditional risk factors include systolic blood pressure, diabetes, adiposity, cholesterol and smoking. The prevalence and distribution of these risk factors in the population have changed within the last decades and CVD mortality rates have been declining. However, the impact of these changes on the contribution of the single risk factors to overall CVD risk remains to be investigated. Hypothesis: We assessed the hypothesis that the population attributable risk (PAR) of traditional risk factors changes from 1985 to 2000. Methods: The sample comprises N = 11 760 participants aged 30 - 65 years from four prospective population-based cohort studies enrolled in Southern Germany in 1985, 1990, 1995, and 2000. Participants were followed up for incident CVD events for ten years. We analyzed the traditional risk factors hypertension, defined as systolic blood pressure ≥ 140 mmHg or treatment with antihypertensive medication; diabetes mellitus; obesity, defined as a Body Mass Index ≥ 30 kg/m 2 ; hypercholesterolemia, defined as total cholesterol levels ≥ 200 mg/dL; and smoking. We calculated the PAR first according to Levin’s formula using both crude relative risks as well as adjusted hazard ratios and second as an average of all single sequential PARs according to the formulae by Ferguson. Results: Temporal trends in prevalence varied for the respective risk factors. The prevalence of hypertension decreased slightly for women (from 25.0% in 1985 to 23.0% in 2000) and increased slightly for men (32.3% to 33.3%), whereas the prevalence of diabetes and obesity increased for both women and men. Prevalence of hypercholesterolemia decreased slightly for women (from 73.4% to 71.4%) and more pronounced for men (80.5% to 74.5%). Prevalence of smoking increased for women (20% to 23.6%), but decreased for men (36.4% to 32.4%). CVD events occurred in 2.4% of women in 1985 and 2.3% in 2000; for men, event rates were and 6.2% and 6.3%, respectively. For both women and men the risk factor with the highest PAR in 1985 was hypertension (64.0% and 43.3%, respectively according to Levin’s formula). However, in 2000 the risk factor with the highest PAR was hypercholesterolemia (78.2% and 57.0%, respectively). The PAR for diabetes declined for women and increased for men. The PAR for smoking varied substantially between the studies without a discernible trend. According to Ferguson’s formulae, the PAR of all risk factors taken together increased from 74.3% to 84.2% in women and from 70.8% to 81.8% in men. Conclusion: In conclusion, the CVD risk attributable to traditional risk factors has increased within the last decades. However, different methods of calculating the PAR have to be taken into account. These trends might influence public health policies focusing on the management of these risk factors in order to effectively prevent CVD.

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Interindividual variability and individual responses to exercise training in adolescents with obesity

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2019-0088 ◽

2020 ◽

Vol 45 (1) ◽

pp. 45-54 ◽

Cited By ~ 3

Author(s):

Jeremy J. Walsh ◽

Jacob T. Bonafiglia ◽

Gary S. Goldfield ◽

Ronald J. Sigal ◽

Glen P. Kenny ◽

...

Keyword(s):

Blood Pressure ◽

Body Composition ◽

Waist Circumference ◽

Exercise Training ◽

Systolic Blood Pressure ◽

Lean Body Mass ◽

Body Fat ◽

Interindividual Variability ◽

Fasting Glucose ◽

Body Fat Mass

This study investigated the impact of exercise training on interindividual variability and response rates in body composition and cardiometabolic outcomes in adolescents with obesity. Postpubertal males and females (n = 143) were randomly assigned to 6 months of a diet-only control or aerobic, resistance, or combined exercise training. Body composition indices were percentages of body fat mass and lean body mass and waist circumference. Biomarkers of cardiometabolic health were systolic blood pressure and plasma fasting glucose, triglycerides, and high-density lipoprotein cholesterol. Interindividual variability was examined by comparing the standard deviation of individual responses (SDIR) to a smallest robust change (SRC). The typical error of measurement was used to classify responses. SDIR exceeded the SRC for percent body fat mass in all exercise groups (SRC = 1.04%; aerobic SDIR = 1.50%; resistance SDIR = 1.22%; combined SDIR = 2.29%), percent lean body mass (SRC = 1.38%; SDIR = 3.2%,), systolic blood pressure (SRC = 2.06 mm Hg; SDIR = 4.92 mm Hg) in the resistance group, and waist circumference (SRC = 2.33 cm; SDIR = 4.09 cm), and fasting glucose (SRC = 0.08 mmol/L; SDIR = 0.28 mmol/L) in the combined group. However, half of the reported variables (11/21) did not have a positive SDIR. Importantly, adverse response rates were significantly lower in all 3 exercise groups compared with control for body composition. Although exercise had a small influence on interindividual variability for indices of body composition, the rate of adverse responses did not increase for any outcome. Novelty Interindividual variability and individual responses to exercise training have not been investigated in adolescents with obesity. Six months of exercise training does not increase interindividual variability in adolescents with obesity. Exercise created a positive, uniform shift in responses.

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The Association of Body Composition Parameters and Simultaneously Measured Inter-Arm Systolic Blood Pressure Differences

Medicina ◽

10.3390/medicina57040384 ◽

2021 ◽

Vol 57 (4) ◽

pp. 384

Author(s):

Serkan Yüksel ◽

Metin Çoksevim ◽

Murat Meriç ◽

Mahmut Şahin

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Body Composition ◽

Systolic Blood Pressure ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Bioelectrical Impedance ◽

The Body ◽

Increased Risk ◽

Group 2

Background and Objectives: An inter-arm systolic blood pressure difference (IASBPD) is defined as a blood pressure (BP) disparity of ≥10 mmHg between arms. IASBPDs are associated with an increased risk of cardiovascular disease (CVD). Similarly, visceral fat accumulation (VFA) is clinically important because it is associated with higher cardiovascular disease risk. Accordingly, this study compared the body composition parameters of IASBPD individuals with individuals who did not express an IASBPD. Materials and Methods: The analysis included 104 patients. The blood pressures of all participants were measured simultaneously in both arms using automated oscillometric devices. Then patients were divided into two groups according to their IASBPD status: Group 1 (IASBPD- (<10 mmHg)); Group 2 (IASPPD+ (≥10 mmHg)). Body composition parameters were measured using bioelectrical impedance analysis. Results: In 42 (40%) patients, the simultaneously measured IASBPD was equal to or higher than 10 mmHg. The right brachial SBP was higher in 63% of patients. There were no differences between the groups in terms of demographic and clinical characteristics. Regarding the two groups’ body composition parameter differences, VFA was significantly higher in group 2 (p = 0.014). Conclusions: The IASBPD is known to be associated with an increased risk of cardiovascular events. Although the body mass indexes (BMIs) of the two groups were similar, VFA levels in those with a greater than 10 mmHg IASBPD were found to be significantly higher. This finding may explain the increased cardiovascular risk in this group.

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Impact of prior cerebrovascular disease and glucose status on incident cerebrovascular disease in Japanese

Cardiovascular Diabetology ◽

10.1186/s12933-021-01367-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Momoko Oe ◽

Kazuya Fujihara ◽

Mayuko Harada-Yamada ◽

Taeko Osawa ◽

Masaru Kitazawa ◽

...

Keyword(s):

Blood Pressure ◽

Glucose Tolerance ◽

Cerebrovascular Disease ◽

Systolic Blood Pressure ◽

Cox Regression ◽

Drug Prescription ◽

Cvd Risk ◽

Cox Regression Analysis ◽

The Impact ◽

Glucose Status

Abstract Background Although both a history of cerebrovascular disease (CVD) and glucose abnormality are risk factors for CVD, few large studies have examined their association with subsequent CVD in the same cohort. Thus, we compared the impact of prior CVD, glucose status, and their combinations on subsequent CVD using real-world data. Methods This is a retrospective cohort study including 363,627 men aged 18–72 years followed for ≥ 3 years between 2008 and 2016. Participants were classified as normoglycemia, borderline glycemia, or diabetes defined by fasting plasma glucose, HbA1c, and antidiabetic drug prescription. Prior and subsequent CVD (i.e. ischemic stroke, transient ischemic attack, and non-traumatic intracerebral hemorrhage) were identified according to claims using ICD-10 codes, medical procedures, and questionnaires. Results Participants’ mean age was 46.1 ± 9.3, and median follow up was 5.2 (4.2, 6.7) years. Cox regression analysis showed that prior CVD + conferred excess risk for CVD regardless of glucose status (normoglycemia: hazard ratio (HR), 8.77; 95% CI 6.96–11.05; borderline glycemia: HR, 7.40, 95% CI 5.97–9.17; diabetes: HR, 5.73, 95% CI 4.52–7.25). Compared with normoglycemia, borderline glycemia did not influence risk of CVD, whereas diabetes affected subsequent CVD in those with CVD- (HR, 1.50, 95% CI 1.34–1.68). In CVD-/diabetes, age, current smoking, systolic blood pressure, high-density lipoprotein cholesterol, and HbA1c were associated with risk of CVD, but only systolic blood pressure was related to CVD risk in CVD + /diabetes. Conclusions Prior CVD had a greater impact on the risk of CVD than glucose tolerance and glycemic control. In participants with diabetes and prior CVD, systolic blood pressure was a stronger risk factor than HbA1c. Individualized treatment strategies should consider glucose tolerance status and prior CVD.

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Urinary sodium excretion and the risk of cardiovascular disease: A community-based cohort study in Taiwan

British Journal Of Nutrition ◽

10.1017/s0007114521001768 ◽

2021 ◽

pp. 1-42

Author(s):

Yi-Jie Wang ◽

Kuo-Lioug Chien ◽

Hsiu-Ching Hsu ◽

Hung-Ju Lin ◽

Ta-Chen Su ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Systolic Blood Pressure ◽

Sodium Excretion ◽

Urinary Sodium Excretion ◽

Salt Sensitivity ◽

Urinary Sodium ◽

Mediating Effect ◽

Cvd Risk ◽

Media Thickness

Abstract Urinary sodium excretion is a potential risk factor for cardiovascular diseases (CVD). However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterize the relative contribution of biological factors to the sodium-CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour sodium excretion was estimated using a single overnight urine sample. Hypertension, metabolic syndrome, and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary sodium excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (standard deviation) of the 2112 participants was 54.5 (12.2) years, and they were followed up for a mean of 14.1 [8.1] years. Compared with those in the lowest quartile, the highest baseline urinary sodium excretion (>4.2g/24 hours) was associated with a 43% higher CVD risk (hazard ratio, 1.43; 95% confidence interval, 1.02-1.99). Participants with high urinary sodium excretion, hypertension, or metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35% of the sodium-CVD association), followed by systolic blood pressure (33%), left ventricular mass (28%), and diastolic blood pressure (14%). Higher urinary sodium excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic blood pressure.

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Consumption of dairy products and cardiovascular disease risk: results from the French prospective cohort NutriNet-Santé

British Journal Of Nutrition ◽

10.1017/s0007114521001422 ◽

2021 ◽

pp. 1-37

Author(s):

Laury Sellem ◽

Bernard Srour ◽

Kim G. Jackson ◽

Serge Hercberg ◽

Pilar Galan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Dairy Products ◽

Disease Risk ◽

Heart Diseases ◽

Cardiovascular Disease Risk ◽

Dietary Intakes ◽

Cvd Risk ◽

Dairy Consumption ◽

Fermented Dairy ◽

The Impact

Abstract In France, dairy products contribute to dietary saturated fat intake, of which reduced consumption is often recommended for cardiovascular disease (CVD) prevention. Epidemiological evidence on the association between dairy consumption and CVD risk remains unclear, suggesting either null or inverse associations. This study aimed to investigate the associations between dairy consumption (overall and specific foods) and CVD risk in a large cohort of French adults. This prospective analysis included participants aged ≥ 18 years from the NutriNet-Santé cohort (2009–2019). Daily dietary intakes were collected using 24h-dietary records. Total dairy, milk, cheese, yogurts, fermented and reduced-fat dairy intakes were investigated. CVD cases (n=1,952) included cerebrovascular (n=878 cases) and coronary heart diseases (CHD, n=1,219 cases). Multivariable Cox models were performed to investigate associations. This analysis included n=104,805 French adults (mean age at baseline 42.8 years (SD 14.6)), mean follow-up 5.5 years (SD 3.0, i.e. 579,155 persons years). There were no significant associations between dairy intakes and total CVD or CHD risks. However, the consumption of at least 160 g/d of fermented dairy (e.g. cheese and yogurts) was associated with a reduced risk of cerebrovascular diseases compared to intakes below 57 g/d (HR=0.81 [0.66-0.98], p-trend=0.01). Despite being a major dietary source of saturated fats, dairy consumption was not associated with CVD or CHD risks in this study. However, fermented dairy was associated with a lower cerebrovascular disease risk. Robust randomized controlled trials are needed to further assess the impact of consuming different dairy foods on CVD risk and potential underlying mechanisms.

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