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Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression.

ABSTRACT: Previous systematic reviews were not restricted to either primary or secondary prevention trials, this study aimed to investigate the effects of reduced and/or modified fat diets and dietary fatty acids on all-cause mortality, cardiovascular mortality and cardiovascular events in participants with established coronary heart disease.Systematic review, meta-analysis and univariate/multivariate meta-regression.Electronic searches for randomised controlled trials comparing reduced/modified fat diets versus control diets were performed in MEDLINE, EMBASE and the Cochrane Library.Pooled effects were calculated using an inverse-variance random effect meta-analysis. Random effects univariate and multivariate meta-regressions were performed including changes in all types of dietary fatty acids.Overall, 12 studies enrolling 7150 participants were included in the present systematic review. No significant risk reduction could be observed considering all-cause mortality (relative risk (RR) 0.92, p=0.60; I(2)=59%) and cardiovascular mortality (RR 0.96, p=0.84; I(2)=69%), combined cardiovascular events (RR 0.85, p=0.30; I(2)=75%) and myocardial infarction (RR 0.76, p=0.13; I(2)=55%) comparing modified fat diets versus control diets. This results could be confirmed for the reduced fat versus control diets (RR 0.79, p=0.47; I(2)=0%), (RR 0.93, p=0.66; I(2)=0%), (RR 0.93, p=0.71; I(2)=57%) and (RR 1.18, p=0.26; I(2)=18%). The multivariate and univariate model showed no significant associations between the independent variables and the changes from saturated fat, monounsaturated fat, polyunsaturated fat and linoleic acid. Sensitivity analyses did not reveal a significant risk reduction for any outcome parameter when polyunsaturated fat was increased in exchange for saturated fat.The present systematic review provides no evidence (moderate quality evidence) for the beneficial effects of reduced/modified fat diets in the secondary prevention of coronary heart disease. Recommending higher intakes of polyunsaturated fatty acids in replacement of saturated fatty acids was not associated with risk reduction.

SUBMITTER: Schwingshackl L

PROVIDER: S-EPMC3996809 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression.

Schwingshackl Lukas L Hoffmann Georg G

BMJ open 20140419 4

<h4>Objective</h4>Previous systematic reviews were not restricted to either primary or secondary prevention trials, this study aimed to investigate the effects of reduced and/or modified fat diets and dietary fatty acids on all-cause mortality, cardiovascular mortality and cardiovascular events in participants with established coronary heart disease.<h4>Design</h4>Systematic review, meta-analysis and univariate/multivariate meta-regression.<h4>Eligibility and criteria for selecting studies</h4>E ...[more]

PMID: 24747790

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Project description:ObjectiveTo evaluate the effectiveness of replacing dietary saturated fat with omega 6 linoleic acid, for the secondary prevention of coronary heart disease and death.DesignEvaluation 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.SettingAmbulatory, coronary care clinic in Sydney, Australia.Participants458 men aged 30-59 years with a recent coronary event.InterventionsReplacement 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 measuresAll 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.ResultsThe 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).ConclusionsAdvice 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 registrationClinical trials NCT01621087.

Dataset Information

Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression.

Publications

Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression.

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