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Intervention Review

Reduced or modified dietary fat for preventing cardiovascular disease

  1. Lee Hooper1,*,
  2. Carolyn D Summerbell2,
  3. Julian PT Higgins3,
  4. Rachel L Thompson4,
  5. Gillian Clements5,
  6. Nigel Capps6,
  7. George Davey Smith7,
  8. Rudolph Riemersma8,
  9. Shah Ebrahim9

Editorial Group: Cochrane Heart Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 31 JAN 2000

DOI: 10.1002/14651858.CD002137

Database Title

Additional Information

How to Cite

Hooper L, Summerbell CD, Higgins JPT, Thompson RL, Clements G, Capps N, Davey Smith G, Riemersma R, Ebrahim S. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002137. DOI: 10.1002/14651858.CD002137.

Author Information

  1. 1

    University of East Anglia, School of Medicine, Health Policy & Practice, Norwich, UK

  2. 2

    University of Teesside, School of Health and Social Care, Middlesbrough, Teesside, UK

  3. 3

    MRC Biostatistics Unit, Cambridge, UK

  4. 4

    Southampton General Hospital, The Wessex Institute for Health R & D, Southampton, Hampshire, UK

  5. 5

    Royal Shrewsbury Hospital NHS Trust, Shrewsbury, UK

  6. 6

    Royal Princess Hospital NHS Trust, Department of Clinical Biochemistry, Telford, UK

  7. 7

    University of Bristol, Department of Social Medicine, Bristol, UK

  8. 8

    University of Edinburgh, Department of Medicine, Cardiovascular Research Unit, Edinburgh, UK

  9. 9

    London School of Hygiene & Tropical Medicine, Department of Epidemiology & Population Health, London, UK

*Lee Hooper, School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, NR4 7TJ, UK. l.hooper@uea.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Reduction or modification of dietary fat can improve total cholesterol levels, but may also have a variety of effects, both positive and negative, on other cardiovascular risk factors.

Objectives

The aim of this systematic review was to assess the effect of reduction or modification of dietary fats on total and cardiovascular mortality and cardiovascular morbidity over at least 6 months, using all available randomized clinical trials.

Search strategy

The Cochrane Library, MEDLINE, EMBASE, CAB Abstracts, CVRCT registry and related Cochrane Groups' trial registers were searched through spring 1998, SIGLE to January 1999. Trials known to experts in the field and biographies were included through May 1999.

Selection criteria

Trials fulfilled the following criteria: 1) randomized with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) healthy adult humans, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available. Inclusion decisions were duplicated, disagreement resolved by discussion or a third party.

Data collection and analysis

Rate data were extracted by two independent reviewers and meta-analysis performed using random effects methodology. Meta-regression and funnel plots were used.

Main results

Twenty seven studies were included (40 intervention arms, 30,901 person-years). There was no significant effect on total mortality (rate ratio 0.98, 95% CI 0.86 to 1.12), a trend towards protection form cardiovascular mortality (rate ratio 0.91, 95% CI 0.77 to 1.07), and significant protection from cardiovascular events (rate ratio 0.84, 95% CI 0.72 to 0.99). The latter became non-significant on sensitivity analysis.

Trials where participants were involved for more than 2 years showed significant reductions in the rate of cardiovascular events and a suggestion of protection from total mortality. The degree of protection from cardiovascular events appeared similar in high and low risk groups, but was statistically significant only in the former.

Authors' conclusions

The findings are suggestive of a small but potentially important reduction in cardiovascular risk in trials longer than two years. Lifestyle advice to all those at high risk of cardiovascular disease (especially where statins are unavailable or rationed), and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Cutting down or changing the fat we eat may reduce our risk of heart disease

Cutting down how much fat we eat or replacing some saturated (animal) fats by plant oils and unsaturated spreads may reduce risk of heart disease, probably including fatal heart disease. Heart disease includes heart attacks, chest pain, strokes and the need for heart surgery. This change in how we eat seems to protect us better if we stick to it for at least two years. People who already have heart disease, and those who do not have heart disease, benefit in the same way.

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