New research by Canadian scientists says junk food causes a third of all heart attacks and it is diets heavy in fried foods, salty snacks and meat which are the culprits.
The study by researchers at McMaster University in Ontario, Canada, included 52 countries and showed that people who ate a "Western" diet based on meat, eggs and junk food were more likely to have heart attacks, while those who ate more fruits and vegetables had a lower risk.
The research adds to growing evidence that show junk food and animal fats can cause heart disease, in particular heart attacks.
Dr. Salim Yusuf and colleagues questioned more than 16,000 patients, 5,700 of whom had just suffered a first heart attack, they took blood samples and had each patient fill out a detailed form on their eating habits between February 1999 and March 2003 and then divided the volunteers into three groups - 'Oriental', 'Western' and 'prudent'.
The 'Oriental' group earned its label because of high levels of tofu and soy and other sauces in the diets.
The 'Western' was so-called because of its high loading on fried food, salty snacks, and meat intake - while the group labeled 'prudent' ate high levels of fruit and vegetables in their diet.
The researchers found that people who ate more fruits and vegetables had a 30% lower risk of heart attack compared to people who ate little or none of these foods - by comparison people eating a Western diet had a 35% greater risk of heart attack, while those eating the "Oriental" diet had an average risk of heart attack compared to the others.
They say the results are important because it has not always been clear if it is food 'per se' or something else driving heart attack risk and rich diets may be associated with a richer lifestyle that includes little or no exercise, for instance.
The researchers say that heart disease is no longer an affliction only of the rich as around 80% of the global cardiovascular disease burden occurs in low and middle-income countries.
The researchers say the tofu-rich diet could be neutral rather than protective because it is high in sodium, which can raise blood pressure and the risk of heart attack and stroke.
The researchers suggest that the same relationships between food and heart disease that are observed in Western countries exist in other regions of the world and lead author Romania Iqbal says 30% of the risk of heart disease in a population could be related to poor diet.
Experts say it is vital that intake of salty, fried, fatty food is reduced to a minimum but the amount of fruit and vegetables must be increased.
The research is published in the journal Circulation.