Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73).
Bottom Line: Control diet was high in saturated fat from animal fats, common margarines, and shortenings.Kaplan Meier graphs showed no mortality benefit for the intervention group in the full randomized cohort or for any prespecified subgroup.There was no evidence of benefit in the intervention group for coronary atherosclerosis or myocardial infarcts.
Affiliation: Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA Chris.Ramsden@nih.gov.Show MeSH
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Mentions: The complete systematic review and meta-analysis following PRISMA guidelines is presented in appendix part 2. Briefly, out of 1270 screened records we identified only five randomized controlled trials that provided vegetable oil(s) rich in linoleic acid in place of saturated fat and were not confounded by unequal application of concomitant interventions. These five trials included 10 808 participants, 324 deaths attributed to coronary heart disease, and 1001 deaths from all causes (table K and L in appendix). The mean change in serum cholesterol concentration in the course of the randomized controlled trials ranged from 7.8% to 13.8% lower in the intervention versus control groups. In meta-analyses of these five trials, there was no evidence of benefit on mortality from coronary heart disease (hazard ratio 1.13, 95% confidence interval 0.83 to 1.54) (fig 7) or all cause mortality (1.07, 0.90 to 1.27) (fig D and E in appendix). In a sensitivity analysis, inclusion of three additional diet-heart trials that provided advice only and/or were confounded by the provision of large quantities of n-3 EPA+DHA did not appreciably alter results for mortality from coronary heart disease (1.00, 0.81 to 1.24) (fig 7) or all cause mortality (1.00, 0.87 to 1.15) (figs H and I in appendix). In sensitivity analyses that included non-fatal endpoints, there was no indication of benefit from the replacement of saturated fat with vegetable oils rich in linoleic acid, with either a composite outcome of myocardial infarcts plus death from coronary heart disease or non-fatal myocardial infarcts alone (fig K and L in appendix). Thus, although limited, available evidence from randomized controlled trials provides no indication of benefit on coronary heart disease or all cause mortality from replacing saturated fat with linoleic acid rich vegetable oils.
Affiliation: Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA Chris.Ramsden@nih.gov.