Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis
Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, Ringel A, Davis JM, Hibbeln JR
BMJ (Clinical research ed.) · 342 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Meta-analysis (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Food provided by researchers
Who paid for it
- Funding
- Independent funding
- University or hospital
- University of New South Wales
- Government
- National Institutes of Health
- Government
- National Center for Complementary and Integrative Health
- Government
- NCCIH NIH HHS
- Government
- Intramural NIH HHS
- Grants
- National Center for Complementary and Integrative Health (T-32 AT003378)
Based on 5 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2013-02-04 · BMJ · vol. 346 · issue feb04 3 · p. e8707
- Cited
- 519 citations · more than 100% of similar papers · 47.2× the field average
- Impact
- Top 10% most cited in its field
- References
- 96 works
- Access
- Open access (hybrid journal) · CC-BY-NC
- Research areas
- Fatty Acid Research and Health · Diet, Metabolism, and Disease · Nutritional Studies and Diet
- Keywords
- Coronary heart disease, Linoleic acid, Meta-analysis, Medicine, Internal medicine, Cardiology, Biology, Biochemistry, Fatty acid
- MeSH
- humans, coronary disease, dietary fats, linoleic acid, plant oils, diet, fat-restricted, epidemiologic methods, adult, middle aged, new south wales, male, secondary prevention
9 authors
From US, AU
- Christopher E. Ramsden · correspondingUniversity of North Carolina at Chapel Hill; National Institutes of Health; National Institute on Alcohol Abuse and Alcoholism
- Daisy ZamoraUniversity of North Carolina at Chapel Hill
- B. LeelarthaepinUNSW Sydney
- Sharon F. Majchrzak‐HongNational Institutes of Health; National Institute on Alcohol Abuse and Alcoholism
- Keturah R. FaurotUniversity of North Carolina at Chapel Hill
- Chirayath SuchindranUniversity of North Carolina at Chapel Hill
Abstract
Objective
To evaluate the effectiveness of replacing dietary saturated fat with omega 6 linoleic acid, for the secondary prevention of coronary heart disease and death.
Design
Evaluation of recovered data from the Sydney Diet Heart Study, a single blinded, parallel group, randomized controlled trial conducted in 1966-73; and an updated meta-analysis including these previously missing data.
Setting
Ambulatory, coronary care clinic in Sydney, Australia.
Participants
458 men aged 30-59 years with a recent coronary event.
Interventions
Replacement of dietary saturated fats (from animal fats, common margarines, and shortenings) with omega 6 linoleic acid (from safflower oil and safflower oil polyunsaturated margarine). Controls received no specific dietary instruction or study foods. All non-dietary aspects were designed to be equivalent in both groups.
Outcome measures
All cause mortality (primary outcome), cardiovascular mortality, and mortality from coronary heart disease (secondary outcomes). We used an intention to treat, survival analysis approach to compare mortality outcomes by group.
Results
The intervention group (n=221) had higher rates of death than controls (n=237) (all cause 17.6% v 11.8%, hazard ratio 1.62 (95% confidence interval 1.00 to 2.64), P=0.05; cardiovascular disease 17.2% v 11.0%, 1.70 (1.03 to 2.80), P=0.04; coronary heart disease 16.3% v 10.1%, 1.74 (1.04 to 2.92), P=0.04). Inclusion of these recovered data in an updated meta-analysis of linoleic acid intervention trials showed non-significant trends toward increased risks of death from coronary heart disease (hazard ratio 1.33 (0.99 to 1.79); P=0.06) and cardiovascular disease (1.27 (0.98 to 1.65); P=0.07).
Conclusions
Advice to substitute polyunsaturated fats for saturated fats is a key component of worldwide dietary guidelines for coronary heart disease risk reduction. However, clinical benefits of the most abundant polyunsaturated fatty acid, omega 6 linoleic acid, have not been established. In this cohort, substituting dietary linoleic acid in place of saturated fats increased the rates of death from all causes, coronary heart disease, and cardiovascular disease. An updated meta-analysis of linoleic acid intervention trials showed no evidence of cardiovascular benefit. These findings could have important implications for worldwide dietary advice to substitute omega 6 linoleic acid, or polyunsaturated fats in general, for saturated fats.
Trial registration
Clinical trials NCT01621087.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
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