Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association
Frank M Sacks, Alice H Lichtenstein, Jason H Y Wu, Lawrence J Appel, Mark A Creager, Penny M Kris-Etherton, Michael Miller, Eric B Rimm, Lawrence L Rudel, Jennifer G Robinson, Neil J Stone, Linda V Van Horn, American Heart Association - Circulation, 2017
This American Heart Association consensus advisory concludes that replacing saturated fat with polyunsaturated vegetable oil lowers cardiovascular disease risk by roughly 30%, comparable to statin therapy, and recommends reducing saturated fat. The skeptic-relevant caveat is in the same abstract: replacing saturated fat with mostly refined carbohydrates and sugars is not associated with lower cardiovascular rates, so the benefit depends on what replaces the saturated fat.
Key findings
- Randomized trials that replaced dietary saturated fat with polyunsaturated vegetable oil reduced cardiovascular disease by about 30%, similar to the reduction achieved by statin treatment.
- Replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of cardiovascular disease - the benefit depends on the replacement nutrient.
- The advisory recommends lowering saturated fat intake and replacing it with unsaturated, especially polyunsaturated, fat.
Effect measures
- Relative Risk Reduction: approximately 30%Not reported in abstract
- Other: No association (null)
Why this evidence tier (Moderate)
- Risk of bias:
- A consensus advisory and narrative synthesis rather than a primary trial; conclusions depend on which older RCTs the writing group selected to pool, a selection some critics dispute.
- Precision:
- The headline approximately 30% figure is reported without a confidence interval in the abstract, so its precision is not directly stated.
- Directness:
- Directly addresses dietary saturated fat replacement and clinical cardiovascular disease, the core question, and correctly distinguishes the replacement nutrient.
- Consistency:
- Broadly consistent with the Hooper Cochrane review on events, though the specific approximately 30% magnitude rests on a contested set of older trials.
- Funding / COI:
- An American Heart Association Presidential Advisory prepared and published by the AHA with no external commercial sponsor stated. Individual writing-group members carry disclosures including some food, oil, and pharmaceutical industry relationships, listed in the full document disclosure table rather than the abstract.
Moderate certainty. A mainstream consensus that replacing saturated fat with polyunsaturated fat lowers cardiovascular risk, with the magnitude dependent on a disputed selection of older RCTs and on the replacement nutrient.
- Population:
- Narrative evidence synthesis (AHA Presidential Advisory) reviewing randomized controlled trials and prospective observational cohort studies of dietary saturated fat and its replacement; not an original primary trial with an enrolled population.
- Conflicts of interest:
- An AHA Presidential Advisory with no external commercial sponsor; the AHA required writing-group disclosure questionnaires. Some members carry food, oil, or pharmaceutical industry relationships listed in the full document. A correction was issued (PMID 28874427); no retraction.
- Funding:
- Prepared and published by the American Heart Association; no external commercial sponsor stated.
Limitations
- A consensus advisory and narrative synthesis, not a primary randomized trial.
- A correction/erratum was published (Circulation 2017 Sep 5; 136(10): e195; PMID 28874427); no retraction or expression of concern.
- The approximately 30% figure derives from a pooled set of older RCTs (e.g. Oslo, Finnish Mental Hospital, LA Veterans) whose selection some skeptics dispute.
- The headline ~30% figure rests on a selected set of older saturated-fat-replacement trials (e.g. Oslo, Finnish Mental Hospital, LA Veterans) whose inclusion some critics dispute.