心血管疾病是全球首要死亡原因，每年所致死亡人數(shù)約1730萬。減少心血管疾病的預(yù)防療法即使比例很小，也可大大減少全國和全球發(fā)生心血管疾病的人數(shù)及其醫(yī)療成本。

　　2017年6月15日，美國心臟協(xié)會《循環(huán)》在線發(fā)表協(xié)會官方報告，推薦以多和單不飽和植物油取代飽和脂肪，有助于降低膽固醇、預(yù)防心血管疾病。

　　支持限制飽和脂肪的證據(jù)經(jīng)常在科學(xué)文獻和大眾媒體中受到質(zhì)疑。該報告回顧了現(xiàn)有證據(jù)，并解釋了美國心臟協(xié)會（AHA）長期以來限制高飽和脂肪食物建議背后的科學(xué)框架。

　　第一作者、哈佛大學(xué)陳曾熙公共衛(wèi)生學(xué)院心血管疾病教授弗蘭克·薩克斯表示：希望能夠直觀地記錄科學(xué)研究為何絕對支持限制飲食飽和脂肪預(yù)防心血管疾病，飽和脂肪會增加低密度脂蛋白膽固醇，這是導(dǎo)致動脈阻塞斑塊和心血管疾病的主要原因。

　　飽和脂肪存在于肉類、全脂乳制品、熱帶植物油（例如椰子油、棕櫚油）等。不飽和脂肪包括：玉米油、大豆油、花生油等多不飽和脂肪，橄欖油、菜籽油、紅花油、牛油果油等單不飽和脂肪。

　　該報告要點如下：

• 降低飲食飽和脂肪攝入量并以多不飽和植物油代替的隨機對照研究將心血管疾病減少約30%，與他汀類藥物降低膽固醇的效果相似。

• 許多人群前瞻觀察研究表明，飽和脂肪攝入量較低、多和單不飽和脂肪攝入量較高，與心血管疾病、其他主要原因、全部原因所致死亡率較低有相關(guān)性。

• 相比之下，以大多數(shù)精制碳水化合物和糖取代飽和脂肪，并不降低心血管疾病比例，并未降低臨床研究中的心血管疾病。

• 以不飽和脂肪取代飽和脂肪，可降低引起動脈粥樣硬化的低密度脂蛋白膽固醇，為人群和臨床研究的心血管疾病發(fā)生率降低提供了生物學(xué)證據(jù)。

• 考慮到全部科學(xué)證據(jù)滿足嚴格因果關(guān)系，故強烈建議降低飽和脂肪攝入量并以不飽和（尤其多不飽和）脂肪取代，可以降低心血管疾病發(fā)生率。

• 不建議孤立地將飽和脂肪轉(zhuǎn)變?yōu)椴伙柡椭?，而?yīng)結(jié)合整體的健康飲食模式，例如高血壓飲食或地中海飲食，正如2013年美國心臟協(xié)會（AHA）和美國心臟病學(xué)會（ACC）生活方式指南、2015～2020年美國人飲食指南所強調(diào)的。

• 高血壓飲食：1997年開展的飲食方法防止高血壓（Dietary Approaches to Stop Hypertension，DASH）發(fā)現(xiàn)，如果攝入足夠的谷物、蔬菜、水果、低脂或脫脂奶，以維持足夠的鉀、鎂、鈣等離子的攝入量，并盡量減少飲食脂肪（尤其是富含飽和脂肪的動物油），限制食鹽攝入量，可以有效降低血壓。因此，現(xiàn)在常以DASH飲食作為預(yù)防及控制高血壓的飲食模式。

• 地中海飲食：泛指希臘、西班牙、法國、意大利南部等處于地中海沿岸的南歐各國以蔬菜水果、魚類、五谷雜糧、豆類、橄欖油為主的飲食風(fēng)格，研究發(fā)現(xiàn)地中海飲食可以減少心臟病風(fēng)險，還可以保護大腦免受血管損傷，降低卒中和記憶力減退的風(fēng)險?，F(xiàn)在也用地中海式飲食代指有利于健康、簡單、清淡以及富含營養(yǎng)的飲食。

小調(diào)查

Circulation. 2017 Jun 15. [Epub ahead of print]

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association.

Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, Miller M, Rimm EB, Rudel LL, Robinson JG, Stone NJ, Van Horn LV; American Heart Association.

Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.

KEYWORDS: AHA Scientific Statements; blood cholesterol; cardiovascular diseases, atherosclerosis; cholesterol, LDL; dietary fats; fatty acids, saturated; fatty acids, unsaturated

PMID: 28620111

PII: CIR.0000000000000510

DOI: 10.1161/CIR.0000000000000510