MI, Strokes Fell After Trans Fats Ousted From NY Restaurants

Marlene Busko

April 17, 2017

NEW HAVEN, CT — The decline in hospital admissions for MI and stroke was accelerated in certain counties in New York 3 or more years after trans fat was banned in restaurants there compared with other counties that did not have these restrictions, in a new study[1].

This suggests that when the US Food and Drug Administration's restriction on trans fats in the whole food supply takes effect in 2018, the benefit would be the same or even greater, Dr Eric J Brandt (Yale University, New Haven, CT) told heartwire from Medscape.

"You could still get the trans-fat exposure from grocery stores" during this study from 2002 to 2013, but the 2018 FDA national ban "will be a more comprehensive ban, and we will hopefully see the same if not a greater decline in MI and stroke," he said.

Dietary changes can play a big role in patients' cardiovascular risks, he observed. "It's basic but important that diet remains a focus and a cornerstone to managing patients and even before patients have cardiovascular disease, a lifetime of exposure to . . . better health [habits] and nutrition can be extremely impactful."

Trans fats are only one part of the Western diet that could be improved. "There are other dietary and populationwide changes that are also contributing to why we are not seeing a further decline in MI, including obesity, diabetes, and other dietary factors like disproportionately high refined-sugar intake compared with fruit and vegetable intake and other healthy choices," he agreed.

The study was published April 12, 2017 in JAMA Cardiology.

Trans-fat-Free by 2018

In June 2015 the FDA revoked the "generally recognized as safe" status of partially hydrogenated oils. Between 2007 and 2011, 11 of the 62 counties in New York State already restricted the use of trans-fatty acids in restaurants, cafeterias, vending machines, and other eateries, although these fats could still be found in foods sold in grocery stores.

Brandt and colleagues aimed to determine whether these trans-fatty-acid restrictions were associated with fewer cardiovascular events.

They identified nine counties in New York state with trans-fat restrictions in eateries and eight counties without these restrictions, in large urban areas with more than 1 million residents.

The also identified two counties with these restrictions and 17 counties without these restrictions in smaller urban areas of less than 1 million residents.

The researchers calculated annual rates of hospital admissions for MI and stroke by decade of age, sex, and county, from 2002 through 2013.

In 2006, prior to the restrictions, there were 8.4 million adults in the 11 counties that later implemented the restrictions and there were 3.3 million adults in the other 25 counties.

From 2002 to 2006, the rates of hospitalizations for MI and stroke were already declining in New York state and nationally, likely due to treatment for hypertension and a decline in smoking, Brandt noted.

Three or more years after the implementation of the trans-fat restrictions in eateries, there was a significant additional decline in the combined rate of MI or stroke (the primary outcome) in the counties where this ban was in effect, compared with other counties.

The added decline was equivalent to averting 43 MIs and strokes per 100,000 people per year.

Diving deeper, there was a significant decline in MI and a nonsignificant decline in stroke in the counties with the trans-fat restriction, which agrees with previous literature that trans fats may affect MI more than stroke, according to Brandt.

Additional Decline in Outcome, Counties With vs Without a Trans Fat Ban*

Outcome % (95% CI) P
MI or stroke -6.2 (-9.2 to -3.2) <0.001
MI -7.8 (-12.7 to -2.8) 0.002
Stroke -3.6 (-7.6 to 0.4) 0.08
*3 or more years after the implementation of a ban on trans fats in eateries; data adjusted for decade of age, sex, county, year, and commuting between counties

The results were similar in men and women.

These findings were independent of other health policies in place at the same time. New York City extended a smoking ban in 2011 and implemented a measure to post calorie content on food menus in 2008, but even after researchers excluded New York City from the analysis, there was still an accelerated rate of decline in hospitalizations for MI and stroke in other large urban areas with the trans-fat ban.

Thus, policies that lead to "restrictions on trans-fatty-acid consumption are associated with a decrease in hospitalization for cardiovascular events," the researchers summarize.

This study was supported by the American Medical Association Seed Grant Research Program and the National Center for Advancing Translational Sciences of the National Institutes of Health. The authors report no relevant financial relationships.

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