High plasma
choline has been associated with the
metabolic syndrome and risk of
chronic diseases, including
cardiovascular disease. However, dietary
choline is not correlated with
choline plasma concentrations, and there are few studies and contradictory evidence regarding dietary
choline and cardiovascular events. In addition, a recommended dietary allowance for
choline has not been established and remains a point of contention. This study assessed the association between dietary
choline, including
choline forms, and risk of incident acute
myocardial infarction (AMI) in patients with suspected
stable angina pectoris (SAP). In total 1981 patients (80% men, median age 62) from the Western Norway
B Vitamin Intervention Trial were included in this analysis. Information on dietary
choline was obtained using a 169-item food frequency questionnaire. The
Cardiovascular Disease in Norway project provided data on AMI. Risk associations were estimated using Cox-regression analysis using energy-adjusted
choline intake. Median (25th, 75th percentile) total energy-adjusted
choline intake was 288 (255, 326) mg/d. During a median (25th, 75th percentile) follow-up of 7.5 (6.3, 8.8) years, 312 (15.7%) patients experienced at least one AMI. Increased intakes of energy-adjusted
choline (HR [95% CI] per 50 mg increase 1.11 [1.03, 1.20]),
phosphatidylcholine (HR per 50 mg increase 1.24 [1.08, 1.42]) and
sphingomyelin (HR per 5 mg increase 1.16 [1.02, 1.31]) were associated with higher AMI risk. In conclusion, higher dietary intakes of total
choline,
phosphatidylcholine and
sphingomyelin were associated with increased risk of AMI in patients with SAP. Future studies are necessary to explore underlying mechanisms for this observation.