Q&A: Can Trans-Fatty Acid Bans Improve Heart Health?
It’s one of the most common ingredients in your favorite burger and fries (and other commonly consumed foods). Can banning this ubiquitous ingredient reduce the number of strokes and heart attacks? One recent study compared New York counties that had instituted a ban on trans-fatty acids to those that had not. We asked Einstein Healthcare Network cardiologist Leandro Slipczuk, MD, to explain the study’s findings and its implications.
For the lay reader, what were the findings of this study, and how did the researchers go about it?
Dr. Brandt from Yale University and colleagues checked medical records to see if the New York ban on trans-fatty acids (TFA) made a difference. The answer was yes. The ban was associated with a 6 percent reduction in the number of heart attacks when compared to areas without restrictions.
What are trans-fatty acids, and where are they typically found? What types of foods?
TFA are a type of fat products that are known to increase levels of bad cholesterol (LDL) and triglycerides, reduce good cholesterol (HDL), increase markers of systemic inflammation, and the incidence of heart attacks and strokes. Although some meat and dairy products contain TFA, most of it is formed through an industrial process of hydrogenation that causes oil to be solid at room temperature and food containing it to have a longer shelf life.
This can be found in baked goods (cakes, cookies), snacks (potato, corn and tortilla chips), fast-food (French fries, doughnuts and fried chicken), refrigerator dough (canned biscuits, cinnamon rolls), creamer and margarine.
Food labels must list TFA on the nutrition facts panel if there is more than 0.5 g of TFA per serving.
Are they easy to replace with non-trans-fatty acids?
Food sources that can be used to replace TFA are olive oil and olives, peanut butter and peanut oil, avocados, salad dressings (vegetable oil based), some soft spreads (free of partially hydrogenated oils), seeds (sunflower, pumpkin), nuts or legumes (e.g. peanuts, walnuts, almonds, pistachios, hazelnuts), and tree nut butters (e.g. almond, cashew). See Figure.
(Story continues below.)
This study took place over 11 years. Did the researchers need this much time to come up with their findings, and if so, why?
Studying preventive diet effects on cardiovascular outcomes requires many years because atherosclerosis (fat deposited in the vessels creating blockages with subsequent heart attacks and strokes) develops over decades.
A lay reader might look at the results—a more than 6 percent drop in counties with trans-fatty acids bans—and think, that doesn’t sound like much. Why would we think that it is?
This is actually a big and important number. This study showed a decrease of 6.2 percent in the number of heart attacks in New York counties. We know that in the U.S., every 43 seconds someone has a heart attack, representing 735,000 Americans with a heart attack per year. Inferring a similar effect on the whole Nation, approximately 45,570 heart attacks per year could be prevented by a National ban.
What’s your take on the results? Do they justify trans-fatty acid bans more broadly, or do we need more research?
I think the ban is very important. The harmful effects of TFA on cardiovascular health have been also seen in other trials and known for years. Moreover, the deleterious effect on health of these fats can be seen with the intake of only small amounts. TFA are more common in fast-food and lower-income populations are at particular risk as this sometimes represents the easier or more accessible type of food in certain under-privileged areas. As examples, a large order of Popeye’s Louisiana Kitchen Cajun fries contains 3.5 g of trans-fatty acids per serving and Taco Bell’s Cinnabon Delights (12-pack) contain 2.0 g of trans-fatty acids per serving.