Circulation: Volume 94, Number 11; Pages: 2720-2727; December 1, 1996 
Intake of Dietary Fiber and Risk of Coronary Heart Disease in a Cohort 
of Finnish Men

The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study
Pirjo Pietinen, DSc; Eric B. Rimm, ScD; Pasi Korhonen, MSc; Anne M. 
Hartman, MS; Walter C. Willett, MD; Demetrius Albanes, MD; Jarmo 
Virtamo, MD 
© 1996 by the American Heart Association 
Background Even though dietary fiber has been hypothesized to reduce the 
risk of coronary heart disease, few large epidemiological studies have 
examined this relation with good methodology.

Methods and Results The Alpha-Tocopherol, Beta-Carotene Cancer Prevention
Study was a randomized, double-blind, placebo-controlled trial with daily
supplementation of alpha-tocopherol and/or beta-carotene. Of the
participants, 21 930 smoking men aged 50 to 69 years who were free of
diagnosed cardiovascular disease and had completed a validated dietary
questionnaire at baseline were followed for 6.1 years. We monitored the
incidence of major coronary events (a combination of first nonfatal
myocardial infarction and coronary heart disease death; n=1399) and
mortality from coronary heart disease (n=635). Both entities had a
significant inverse association with dietary fiber, but the association was
stronger for coronary death. For men in the highest quintile of total
dietary fiber intake (median, 34.8 g/d), the relative risk for coronary
death was 0.69 (95% confidence 
interval, 0.54 to 0.88; P<.001 for trend) compared with men in the lowest
quintile of intake (median, 16.1 g/d). With an adjustment for known
cardiovascular risk factors, intake of saturated fatty acids,
beta-carotene, vitamin C, and vitamin E did not materially change the
result. Water-soluble fiber was slightly more strongly associated with
reduced coronary death than water-insoluble fiber, and cereal fiber also
had a stronger association than vegetable or fruit fiber.

Conclusions These findings suggest that independent of other risk factors,
greater intake of foods rich in fiber can substantially reduce the risk of
coronary heart disease, and particularly coronary death, in middle-aged,
smoking men.