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Trans fatty acid restrictions in NY linked to lower hospitalizations for MI, stroke
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Hospitalizations for MI and stroke declined in New York 10 years after the implementation of trans fatty acid restrictions in eateries, according to findings published in JAMA Cardiology.
The restriction was enforced in bakeries, restaurants, cafeterias, caterers, senior meal programs, soup kitchens, mobile food-vending units and other establishments.
Data for MI and stroke hospitalizations for New York state from 2002 to 2013 were reviewed from December 2014 to July 2016. As the restriction was only executed in vastly urban counties, researchers compared those counties with counties without restrictions and similar urban settings. Eleven counties with restrictions and 25 counties without restrictions were analyzed.
To ensure that New York City did not guide the results, sensitivity analyses were performed. The primary outcome was a composite of stroke and MI event rates. Individual events of MI and stroke were the secondary outcomes.
Before the trans fatty acid restrictions were enforced, hospital admission rates were declining in New York. A significant decline was noted for hospitalizations for the primary outcome 3 or more years after the restrictions were enacted vs. counties without restrictions (–6.2%; 95% CI, –9.2 to –3.2), which equals to 43 events that were avoided for every 100,000 people.
According to the researchers, there was a significant decline in MI (–7.8%; 95% CI, –12.7 to –2.8), but the decline was not as substantial for stroke (–3.6%; 95% CI, –7.6 to –0.4). Men and women experienced similar results for secondary outcomes.
After sensitivity analyses for the removal of results from New York City, results remained unchanged.
The restriction on trans fatty acids was implemented when other health regulations were enforced, which may have also lowered hospitalizations for stroke and MI. In New York City, smoking was banned in parks and beaches, and caloric information was required to be posted on food menus.
“However, our results remained significant for [Urban Influence Code 1] populations when excluding NYC from the analyses,” Eric J. Brandt, MD, clinical fellow at Yale University School of Medicine, and colleagues wrote. “As a result, it is unlikely that our results were confounded by the public health measures.” – by Darlene Dobkowski
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Udho Thadani, MD, MRCP, FRCPC, FACC, FAHA
Trans fatty acids have been blamed for adverse CV outcomes, including sudden cardiac death, increased risk for stroke and CHD. Trans fatty acids primarily enter the diet via partially hydrogenated oils, and the FDA has prohibited the unrestricted use of partially hydrogenated oils in all foods without prior approval by 2018.
The current retrospective observational study by Brandt and colleagues goes a step further by showing that by restricting the use of trans fatty acids in both large and small counties in New York State had beneficial effects on the primary discharge diagnosis of a combined endpoint of stroke and MI. It is of interest that this was mainly due to a statistically significant reduction in rates of MI. Although the trend of stroke reduction rate was in the right direction, it did not reach statistical significance. Similar was the case with total mortality rates.
The study has its limitations, as it was a retrospective observational study, and many of the unknown confounding variables could have accounted for these results. Also, the authors were unable to address the influence of restricting trans fatty acids from food in high-risk African American and Hispanic populations. It remains unknown if there is a link between intake of trans fatty acids and increased CV risk. One will need a very large, controlled, randomized outcome study to confirm these results. However, until such time, it seems prudent to restrict or warn patients regarding the use of trans fatty acids in foods. This could be akin to the recommended abstinence from smoking tobacco to improve public health, by reducing the incidence of adverse CV outcomes.
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