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June 26, 1991, Vol 265, No. 24 >
ARTICLE | June 26, 1991

What If Americans Ate Less Fat?: Title and subTitle BreakA Quantitative Estimate of the Effect on Mortality FREE

Warren S. Browner, MD, MPH; Janice Westenhouse, MPH; Jeffrey A. Tice
[+] Author Affiliations

Reprint requests to General Internal Medicine Section, VA Medical Center 111A1, San Francisco, CA 94121 (Dr Browner).


JAMA. 1991;265(24):3285-3291. doi:10.1001/jama.1991.03460240081032
Text Size: A A A
Published online
Article
References

Americans consume an average of 37% of their energy intake as fat. Many authorities recommend restricting fat intake to 30% of energy intake to reduce the rates of coronary heart disease and perhaps of cancers of the breast, colon, and prostate. Based on the assumptions that underlie those recommendations, we estimated the effect of this dietary change on mortality. If all Americans restricted their intake of dietary fat by reducing consumption of saturated fat and accompanying dietary cholesterol, the corresponding reductions in serum cholesterol levels could reduce coronary heart disease mortality rates by 5% to 20%, depending on age. If the relationship between dietary fat and cancer is as strong as has been observed in some studies, the proportional effects on mortality from fat-related cancers could be even greater, although the absolute effects—given the lower mortality rates—would be smaller. Overall, if the assumptions are correct, about 42 000 of the 2.3 million deaths that would have occurred in adults each year in the United States could be deferred. This 2% benefit, equivalent to an increase in average life expectancy of 3 to 4 months, would accrue chiefly to people over the age of 65 years. If recent concerns about the possibly harmful effects of cholesterol lowering on mortality from noncardiovascular causes— which mainly affect younger persons—are valid, these relatively modest benefits would be overestimates of the actual effect.

(JAMA. 1991;265:3285-3291)

REFERENCES

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Page I, Allen E, Chamberlain F, Keys A, Stamler J, Stare F.  Dietary fat and its relation to heart attacks and strokes . Circulation . 1961;; 23:133-136.
2 +
Select Committee on Nutrition and Human Needs, US Senate. Dietary Goals for the United States. Washington, DC: US Government Printing Office; 1977. Publication 052-070-03913-2.
3 +
Food and Nutrition Board National Research Council. Dietary Fat and Human Health . Washington, DC: National Academy of Sciences; 1966;.
4 +
Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention . Washington, DC: Dept of Health, Education, and Welfare; 1979;. DHEW (PHS) publication 79-55071.
5 +
Inter-Society Commission for Heart Disease Resources.  Optimal resources for primary prevention of atherosclerotic diseases . Circulation . 1984;;70:153A-205A.
6 +
 Lowering blood cholesterol to prevent heart disease . JAMA . 1985;;253:2080-2086. NIH Consensus Conference.
7 +
The Surgeon General's Report on Nutrition and Health . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1988;.
8 +
Pooling Project Research Group.  Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling Project . J Chron Dis. 1978;;31:201-306.
9 +
Martin MJ, Browner WS, Hulley SB, Kuller LH, Wentworth D.  Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361662 men . Lancet . 1986;;2:933-936.
10 +
Anderson KM, Castelli WP, Levy D.  Cholesterol and mortality: 30 years follow-up from the Framingham Study . JAMA . 1987;;257:2176-2180.
11 +
 Lipid Research Clinics Program. The Lipid Research Clinics coronary primary prevention trial results, II: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA . 1984;;251:365-374.
12 +
Tyroler H.  Review of lipid-lowering trials in relation to observational epidemiologic studies . Circulation . 1987;;76:515-522.
13 +
 National Cholesterol Education Program. Report of the National Cholesterol Education Program Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol . Arch Intern Med. 1988;;148:36-39.
14 +
Committee on Diet, Nutrition, and Cancer, National Academy of Sciences. Diet, Nutrition, and Cancer . Washington, DC: National Academy Press; 1982;.
15 +
Nutrition and Cancer: Cause and Prevention: Special Report . New York, NY: American Cancer Society; 1984;.
16 +
National Cancer Institute. Cancer Prevention . Washington, DC: US Dept of Health and Human Services; 1984;. NIH publication 84-2671.
17 +
Gray GE, Pike MC, Henderson BE.  Breastcancer incidence and mortality rates in different countries in relation to known risk factors and dietary practices . Br JCancer. 1978;;39:1-7.
18 +
Ingram DM.  Trends in diet and breast cancer mortality in England and Wales 1928-1977 . Nutr Cancer. 1981;;3:75-80.
19 +
Rose DP, Boyar AP, Wynder EL.  International comparisons of mortality rates for cancer of the breast, ovary, prostate, and colon, and per capita food consumption . Cancer. 1986;;58:2363-2371.
20 +
Armstrong B, Doll R.  Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practice . Int J Cancer. 1974;;15:617-631.
21 +
Jain M, Cook GM, Davis FG, Grace MG, Howe GR, Miller AB.  A case-control study of diet and colo-rectal cancer . Int J Cancer. 1980;;26:757-768.
22 +
Potter JD, McMichael AJ.  Diet and cancer of the colon and rectum: a case-control study . J Natl Cancer Inst. 1986;;76:557-569.
23 +
Willett WC, MacMahon B.  Diet and cancer—an overview . N Engl J Med. 1984;;310:633-638, 697-703.
24 +
Snowdon DA, Phillips RL, Choi W.  Diet, obesity, and risk of fatal prostate cancer . Am J Epidemiol. 1984;;120:244-250.
25 +
Haenszel W, Berg JW, Segi M, Kurihara M, Locke FB.  Large-bowel cancer in Hawaiian Japanese . J Natl Cancer Inst. 1973;;51:1765-1779.
26 +
Braden LM, Carroll KK.  Dietary polyunsaturated fat in relation to mammary carcinogenesis in rats . Lipids . 1986;;21:285-288.
27 +
Hopkins GJ, Kennedy TG, Carroll KK.  Polyunsaturated fatty acids as promoters of mammary carcinogenesis induced in Sprague-Dawley rats by 7,12-dimethylbenz[a]anthracene . J Natl Cancer Inst. 1981;;66:517-522.
28 +
Chan PC, Ferguson KA, Dao TL.  Effects of different dietary fats on mammary carcinogenesis . Cancer Res. 1983;;43:1079-1083.
29 +
Kritchevsky D.  Dietary fat versus caloric content in initiation and promotion of 7,12-dimethylbenz[a]anthracene-induced mammary tumorigenesis in rats . Cancer Res. 1984;;44:3174-3177.
30 +
Dao TL, Chan PC.  Effect of duration of high fat intake on enhancement of mammary carcinogenesis in rats . J Natl Cancer Inst. 1983;;71:201-205.
31 +
Boissonneault GA, Elson CE, Pariza MW.  Net energy effects of dietary fat on chemically induced mammary carcinogenesis in F344 rats . J Natl Cancer Inst. 1986;;76:335-338.
32 +
Bull A, Soullier BK, Wilson PS, Hayden MT, Nigro ND.  Promotion of azoxymethane-induced intestinal cancer by high-fat diet in rats . Cancer Res. 1979;;39:4956-4959.
33 +
Bansal BR, Rhoads JE Jr, Bansal SC.  Effects of diet on colon carcinogenesis and the immune system in rats treated with 1,2-dimethylhydrazine . Cancer Res. 1978;;38:3293-3303.
34 +
Willett WC, Stampfer MJ, Colditz GA.  Dietary fat and the risk of breast cancer . N Engl J Med. 1987;;316:22-28.
35 +
Rohan TE, McMichael AJ, Baghurst PA.  A population-based case-control study of diet and breast cancer in Australia . Am J Epidemiol. 1988;;128:478-489.
36 +
Graham S, Dayal H, Swanson M, Mittelman A, Wilkinson G.  Diet in the epidemiology of cancer of the colon and rectum . J Natl Cancer Inst. 1978;;61:709-714.
37 +
Macquart-Moulin G, Riboli E, Cornee J, Charnay B, Berthezene P, Day N.  Case-control study on colorectal cancer and diet in Marseilles . Int J Cancer. 1986;;38:183-191.
38 +
Heshmat MY, Kaul L, Kovi J, et al.  Nutrition and prostate cancer: a case-control study . Prostate . 1985;;6:7-17.
39 +
Graham S, Haughey B, Marshall J, et al.  Diet in the epidemiology of carcinoma of the prostate gland . J Natl Cancer Inst. 1983;;70:687-692.
40 +
Current Population Reports . Washington, DC: US Bureau of the Census; 1988;. Series p-25, No. (1000) .
41 +
National Center for Health Statistics. Vital Statistics of the United States, 1985, II: Mortality, Part A . Washington, DC: US Dept of Health and Human Services; 1988;.
42 +
National Cancer Institute. 1987 Annual Cancer Statistics Review . Washington, DC: US Dept of Health and Human Services; 1988;. NIH publication 88-2789.
43 +
National Center for Health Statistics. Dietary Intake Source Data: United States, 1976-80 . Washington, DC: US Dept of Health and Human Services; 1983;. DHHHS publication (PHS) 83-1681. Data from the National Health Survey.
44 +
National Center for Health Statistics. Dietary Intake and Cardiovascular Risk Factors, Part II: Serum Urate, Serum Cholesterol, and Correlates . Washington, DC: US Dept of Health and Human Services; 1983;. DHHS publication (PHS) 83-1677.
45 +
Miller AB, Kelly A, Choi NW, et al.  A study of diet and breast cancer . Am J Epidemiol. 1978;;107:499-509.
46 +
Van'T Veer P, Kok F, Brants H, Ockhuizen T, Sturmans F, Hermus R.  Dietary fat and the risk of breast cancer . Int J Epidemiol. 1990;;19:12-18.
47 +
Prentice R, Kakar F, Hursting S, Sheppard L, Klein R, Kushi L.  Aspects of the rationale for the Women's Health Trial . J Natl Cancer Inst. 1988;;80:802-814.
48 +
Kannel WB, Neaton JD, Wentworth D, et al.  Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT . Am Heart J. 1986;; 112:825-836.
49 +
Harris T, Cook EF, Kannel WB, Goldman L.  Proportional hazards analysis of risk factors for coronary heart disease in individuals aged 65 or older . J Am Geriatr Soc. 1988;;36:1023-1028.
50 +
Castelli WP, Garrison RJ, Wilson PWF, Abbott RD, Kalousdian S, Kannel WB.  Incidence of coronary heart disease and lipoprotein cholesterol levels . JAMA . 1986;;256:2835-2838.
51 +
Johnson JL, Heineman EF, Heiss G, Hames CG, Tyroler HA.  Cardiovascular disease risk factors and mortality among black women and white women aged 40-64 years in Evans County, Georgia . Am J Epidemiol. 1986;;123:209-220.
52 +
Kannel WB.  Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study . Am Heart J. 1987;;114:413-419.
53 +
Kannel WB.  Cholesterol and risk of coronary heart disease and mortality in men . Clin Chem. 1988;;34( (suppl B) ):B53-B59.
54 +
Pekkanen J, Linn S, Heiss G, et al.  Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease . N Engl J Med. 1990;;322:1700-1707.
55 +
Keys A, Anderson J, Grand F.  Serum cholesterol in response to changes in the diet, II: the effect of cholesterol in the diet . Metabolism . 1965;;14:759-765.
56 +
Keys A, Grande F, Watson L.  Bias and misrepresentation revisited: perspective in saturated fat . Am J Clin Nutr. 1974;;34:188-212.
57 +
Hegstedt D, McGandy R, Myers M, et al.  Quantitative effects of dietary fat on serum cholesterol in man . Am J Clin Nutr. 1965;;17:281-295.
58 +
Ernst N, Fisher M, Bowen P, Schaefer E, Levy R.  Changes in plasma lipids and lipoproteins after a modified fat diet . Lancet . 1980;;2:111-113.
59 +
Jones D, Judd J, Taylor P, Campbell W, Nair P.  Influence of caloric composition and saturation of dietary fat on plasma lipids in premenopausal women . Am J Clin Nutr. 1987;;45:1451-1456.
60 +
 Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA . 1984;;251:351-364.
61 +
Hill A. Principles of Medical Statistics . London, England: Oxford University Press; 1971;:220-228.
62 +
Schatzkin A, Hoover R, Tayler P, et al.  Serum cholesterol and cancer in the NHANESI Epidemiologic Follow-up Study . Lancet . 1987;;2:298-301.
63 +
Isles C, Holes D, Gillis C, et al.  Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey . BMJ . 1989;;298:920-924.
64 +
Cowan L, O'Connell D, Criqui M, et al.  Cancer mortality and lipid and lipoprotein levels: the Lipid Research Clinics Program Mortality Follow-up Study . Am J Epidemiol. 1990;;131:468-482.
65 +
Hiatt R, Fireman B.  Serum cholesterol and the incidence of cancer in a large cohort . J Chron Dis. 1986;;39:861-870.
66 +
Sherwin R, Wentworth D, Cutler J, Hulley SB, Kuller L, Stamler J.  Serum cholesterol levels and cancer mortality in 361,662 men screened for the Multiple Risk Factor Intervention Trial . JAMA . 1987;;257:943-948.
67 +
Knekt P, Reunanen A, Aromaa A, et al.  Serum cholesterol and risk of cancer in a cohort of 39,000 men and women . J Clin Epidemiol. 1988;;41:519-530.
68 +
Muldoon M, Manuck S, Matthews K.  Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ . 1990;;310:309-314.
69 +
Newman TB, Browner WS, Hulley SB.  The case against childhood cholesterol screening . JAMA . 1990;;264:3039-3043.
70 +
Ravenholt R.  Tobacco's impact on twentieth-century U.S. mortality rates . Am J Prev Med. 1985;;1:4-17.
71 +
Committee on Trauma Research. Injury in America: A Continuing Public Health Problem . Washington, DC: National Academy Press; 1985;: 23.
72 +
Robertson L. Injuries—Causes, Control Strategies, and Public Policy . Lexington, Mass: Lexington Books; 1983;:9.
73 +
Browner WS.  Estimating the impact of risk factor modification programs . Am J Epidemiol. 1986;;123:143-153.
74 +
Goldman L, Cook E.  The decline in ischemic heart disease mortality rates . Ann Intern Med. 1984;;101:825-836.
75 +
Taylor W, Pass T, Shepard D, Komaroff A.  Cholesterol reduction and life expectancy: a model incorporating multiple risk factors . Ann Intern Med. 1987;;106:605-614.
76 +
Weinstein MC, Coxson PG, Williams LW, Pass TM, Stason WB, Goldman L.  Forecasting coronary heart disease incidence, mortality, and cost: the coronary heart disease policy model . Am J Public Health. 1987;;77:1417-1426.
77 +
Fisher M, Levine P, Leaf A.  n-3 fatty acids and cellular aspects of atherosclerosis . Arch Intern Med. 1989;;149:1726-1728.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Page I, Allen E, Chamberlain F, Keys A, Stamler J, Stare F.  Dietary fat and its relation to heart attacks and strokes . Circulation . 1961;; 23:133-136.
2 +
Select Committee on Nutrition and Human Needs, US Senate. Dietary Goals for the United States. Washington, DC: US Government Printing Office; 1977. Publication 052-070-03913-2.
3 +
Food and Nutrition Board National Research Council. Dietary Fat and Human Health . Washington, DC: National Academy of Sciences; 1966;.
4 +
Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention . Washington, DC: Dept of Health, Education, and Welfare; 1979;. DHEW (PHS) publication 79-55071.
5 +
Inter-Society Commission for Heart Disease Resources.  Optimal resources for primary prevention of atherosclerotic diseases . Circulation . 1984;;70:153A-205A.
6 +
 Lowering blood cholesterol to prevent heart disease . JAMA . 1985;;253:2080-2086. NIH Consensus Conference.
7 +
The Surgeon General's Report on Nutrition and Health . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1988;.
8 +
Pooling Project Research Group.  Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling Project . J Chron Dis. 1978;;31:201-306.
9 +
Martin MJ, Browner WS, Hulley SB, Kuller LH, Wentworth D.  Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361662 men . Lancet . 1986;;2:933-936.
10 +
Anderson KM, Castelli WP, Levy D.  Cholesterol and mortality: 30 years follow-up from the Framingham Study . JAMA . 1987;;257:2176-2180.
11 +
 Lipid Research Clinics Program. The Lipid Research Clinics coronary primary prevention trial results, II: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA . 1984;;251:365-374.
12 +
Tyroler H.  Review of lipid-lowering trials in relation to observational epidemiologic studies . Circulation . 1987;;76:515-522.
13 +
 National Cholesterol Education Program. Report of the National Cholesterol Education Program Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol . Arch Intern Med. 1988;;148:36-39.
14 +
Committee on Diet, Nutrition, and Cancer, National Academy of Sciences. Diet, Nutrition, and Cancer . Washington, DC: National Academy Press; 1982;.
15 +
Nutrition and Cancer: Cause and Prevention: Special Report . New York, NY: American Cancer Society; 1984;.
16 +
National Cancer Institute. Cancer Prevention . Washington, DC: US Dept of Health and Human Services; 1984;. NIH publication 84-2671.
17 +
Gray GE, Pike MC, Henderson BE.  Breastcancer incidence and mortality rates in different countries in relation to known risk factors and dietary practices . Br JCancer. 1978;;39:1-7.
18 +
Ingram DM.  Trends in diet and breast cancer mortality in England and Wales 1928-1977 . Nutr Cancer. 1981;;3:75-80.
19 +
Rose DP, Boyar AP, Wynder EL.  International comparisons of mortality rates for cancer of the breast, ovary, prostate, and colon, and per capita food consumption . Cancer. 1986;;58:2363-2371.
20 +
Armstrong B, Doll R.  Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practice . Int J Cancer. 1974;;15:617-631.
21 +
Jain M, Cook GM, Davis FG, Grace MG, Howe GR, Miller AB.  A case-control study of diet and colo-rectal cancer . Int J Cancer. 1980;;26:757-768.
22 +
Potter JD, McMichael AJ.  Diet and cancer of the colon and rectum: a case-control study . J Natl Cancer Inst. 1986;;76:557-569.
23 +
Willett WC, MacMahon B.  Diet and cancer—an overview . N Engl J Med. 1984;;310:633-638, 697-703.
24 +
Snowdon DA, Phillips RL, Choi W.  Diet, obesity, and risk of fatal prostate cancer . Am J Epidemiol. 1984;;120:244-250.
25 +
Haenszel W, Berg JW, Segi M, Kurihara M, Locke FB.  Large-bowel cancer in Hawaiian Japanese . J Natl Cancer Inst. 1973;;51:1765-1779.
26 +
Braden LM, Carroll KK.  Dietary polyunsaturated fat in relation to mammary carcinogenesis in rats . Lipids . 1986;;21:285-288.
27 +
Hopkins GJ, Kennedy TG, Carroll KK.  Polyunsaturated fatty acids as promoters of mammary carcinogenesis induced in Sprague-Dawley rats by 7,12-dimethylbenz[a]anthracene . J Natl Cancer Inst. 1981;;66:517-522.
28 +
Chan PC, Ferguson KA, Dao TL.  Effects of different dietary fats on mammary carcinogenesis . Cancer Res. 1983;;43:1079-1083.
29 +
Kritchevsky D.  Dietary fat versus caloric content in initiation and promotion of 7,12-dimethylbenz[a]anthracene-induced mammary tumorigenesis in rats . Cancer Res. 1984;;44:3174-3177.
30 +
Dao TL, Chan PC.  Effect of duration of high fat intake on enhancement of mammary carcinogenesis in rats . J Natl Cancer Inst. 1983;;71:201-205.
31 +
Boissonneault GA, Elson CE, Pariza MW.  Net energy effects of dietary fat on chemically induced mammary carcinogenesis in F344 rats . J Natl Cancer Inst. 1986;;76:335-338.
32 +
Bull A, Soullier BK, Wilson PS, Hayden MT, Nigro ND.  Promotion of azoxymethane-induced intestinal cancer by high-fat diet in rats . Cancer Res. 1979;;39:4956-4959.
33 +
Bansal BR, Rhoads JE Jr, Bansal SC.  Effects of diet on colon carcinogenesis and the immune system in rats treated with 1,2-dimethylhydrazine . Cancer Res. 1978;;38:3293-3303.
34 +
Willett WC, Stampfer MJ, Colditz GA.  Dietary fat and the risk of breast cancer . N Engl J Med. 1987;;316:22-28.
35 +
Rohan TE, McMichael AJ, Baghurst PA.  A population-based case-control study of diet and breast cancer in Australia . Am J Epidemiol. 1988;;128:478-489.
36 +
Graham S, Dayal H, Swanson M, Mittelman A, Wilkinson G.  Diet in the epidemiology of cancer of the colon and rectum . J Natl Cancer Inst. 1978;;61:709-714.
37 +
Macquart-Moulin G, Riboli E, Cornee J, Charnay B, Berthezene P, Day N.  Case-control study on colorectal cancer and diet in Marseilles . Int J Cancer. 1986;;38:183-191.
38 +
Heshmat MY, Kaul L, Kovi J, et al.  Nutrition and prostate cancer: a case-control study . Prostate . 1985;;6:7-17.
39 +
Graham S, Haughey B, Marshall J, et al.  Diet in the epidemiology of carcinoma of the prostate gland . J Natl Cancer Inst. 1983;;70:687-692.
40 +
Current Population Reports . Washington, DC: US Bureau of the Census; 1988;. Series p-25, No. (1000) .
41 +
National Center for Health Statistics. Vital Statistics of the United States, 1985, II: Mortality, Part A . Washington, DC: US Dept of Health and Human Services; 1988;.
42 +
National Cancer Institute. 1987 Annual Cancer Statistics Review . Washington, DC: US Dept of Health and Human Services; 1988;. NIH publication 88-2789.
43 +
National Center for Health Statistics. Dietary Intake Source Data: United States, 1976-80 . Washington, DC: US Dept of Health and Human Services; 1983;. DHHHS publication (PHS) 83-1681. Data from the National Health Survey.
44 +
National Center for Health Statistics. Dietary Intake and Cardiovascular Risk Factors, Part II: Serum Urate, Serum Cholesterol, and Correlates . Washington, DC: US Dept of Health and Human Services; 1983;. DHHS publication (PHS) 83-1677.
45 +
Miller AB, Kelly A, Choi NW, et al.  A study of diet and breast cancer . Am J Epidemiol. 1978;;107:499-509.
46 +
Van'T Veer P, Kok F, Brants H, Ockhuizen T, Sturmans F, Hermus R.  Dietary fat and the risk of breast cancer . Int J Epidemiol. 1990;;19:12-18.
47 +
Prentice R, Kakar F, Hursting S, Sheppard L, Klein R, Kushi L.  Aspects of the rationale for the Women's Health Trial . J Natl Cancer Inst. 1988;;80:802-814.
48 +
Kannel WB, Neaton JD, Wentworth D, et al.  Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT . Am Heart J. 1986;; 112:825-836.
49 +
Harris T, Cook EF, Kannel WB, Goldman L.  Proportional hazards analysis of risk factors for coronary heart disease in individuals aged 65 or older . J Am Geriatr Soc. 1988;;36:1023-1028.
50 +
Castelli WP, Garrison RJ, Wilson PWF, Abbott RD, Kalousdian S, Kannel WB.  Incidence of coronary heart disease and lipoprotein cholesterol levels . JAMA . 1986;;256:2835-2838.
51 +
Johnson JL, Heineman EF, Heiss G, Hames CG, Tyroler HA.  Cardiovascular disease risk factors and mortality among black women and white women aged 40-64 years in Evans County, Georgia . Am J Epidemiol. 1986;;123:209-220.
52 +
Kannel WB.  Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study . Am Heart J. 1987;;114:413-419.
53 +
Kannel WB.  Cholesterol and risk of coronary heart disease and mortality in men . Clin Chem. 1988;;34( (suppl B) ):B53-B59.
54 +
Pekkanen J, Linn S, Heiss G, et al.  Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease . N Engl J Med. 1990;;322:1700-1707.
55 +
Keys A, Anderson J, Grand F.  Serum cholesterol in response to changes in the diet, II: the effect of cholesterol in the diet . Metabolism . 1965;;14:759-765.
56 +
Keys A, Grande F, Watson L.  Bias and misrepresentation revisited: perspective in saturated fat . Am J Clin Nutr. 1974;;34:188-212.
57 +
Hegstedt D, McGandy R, Myers M, et al.  Quantitative effects of dietary fat on serum cholesterol in man . Am J Clin Nutr. 1965;;17:281-295.
58 +
Ernst N, Fisher M, Bowen P, Schaefer E, Levy R.  Changes in plasma lipids and lipoproteins after a modified fat diet . Lancet . 1980;;2:111-113.
59 +
Jones D, Judd J, Taylor P, Campbell W, Nair P.  Influence of caloric composition and saturation of dietary fat on plasma lipids in premenopausal women . Am J Clin Nutr. 1987;;45:1451-1456.
60 +
 Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA . 1984;;251:351-364.
61 +
Hill A. Principles of Medical Statistics . London, England: Oxford University Press; 1971;:220-228.
62 +
Schatzkin A, Hoover R, Tayler P, et al.  Serum cholesterol and cancer in the NHANESI Epidemiologic Follow-up Study . Lancet . 1987;;2:298-301.
63 +
Isles C, Holes D, Gillis C, et al.  Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey . BMJ . 1989;;298:920-924.
64 +
Cowan L, O'Connell D, Criqui M, et al.  Cancer mortality and lipid and lipoprotein levels: the Lipid Research Clinics Program Mortality Follow-up Study . Am J Epidemiol. 1990;;131:468-482.
65 +
Hiatt R, Fireman B.  Serum cholesterol and the incidence of cancer in a large cohort . J Chron Dis. 1986;;39:861-870.
66 +
Sherwin R, Wentworth D, Cutler J, Hulley SB, Kuller L, Stamler J.  Serum cholesterol levels and cancer mortality in 361,662 men screened for the Multiple Risk Factor Intervention Trial . JAMA . 1987;;257:943-948.
67 +
Knekt P, Reunanen A, Aromaa A, et al.  Serum cholesterol and risk of cancer in a cohort of 39,000 men and women . J Clin Epidemiol. 1988;;41:519-530.
68 +
Muldoon M, Manuck S, Matthews K.  Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ . 1990;;310:309-314.
69 +
Newman TB, Browner WS, Hulley SB.  The case against childhood cholesterol screening . JAMA . 1990;;264:3039-3043.
70 +
Ravenholt R.  Tobacco's impact on twentieth-century U.S. mortality rates . Am J Prev Med. 1985;;1:4-17.
71 +
Committee on Trauma Research. Injury in America: A Continuing Public Health Problem . Washington, DC: National Academy Press; 1985;: 23.
72 +
Robertson L. Injuries—Causes, Control Strategies, and Public Policy . Lexington, Mass: Lexington Books; 1983;:9.
73 +
Browner WS.  Estimating the impact of risk factor modification programs . Am J Epidemiol. 1986;;123:143-153.
74 +
Goldman L, Cook E.  The decline in ischemic heart disease mortality rates . Ann Intern Med. 1984;;101:825-836.
75 +
Taylor W, Pass T, Shepard D, Komaroff A.  Cholesterol reduction and life expectancy: a model incorporating multiple risk factors . Ann Intern Med. 1987;;106:605-614.
76 +
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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