Dataset Information

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

ABSTRACT:

Objective

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.

Design

Systematic review, meta-analysis and univariate/multivariate meta-regression.

Eligibility and criteria for selecting studies

Electronic searches for randomised controlled trials comparing reduced/modified fat diets versus control diets were performed in MEDLINE, EMBASE and the Cochrane Library.

Data extraction

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.

Results

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.

Conclusions

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-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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Publications

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.

Project description:BackgroundThis study aimed to investigate knowledge, attitude, and practice (KAP) toward coronary heart disease (CHD) secondary prevention among CHD patients.MethodsThis web-based cross-sectional study enrolled patients with CHD who visited the Yangpu District Central Hospital in Shanghai (China) between October 18, 2022, and March 25, 2023. The administered questionnaire assessed demographic information and KAP; factors associated with good practice were identified by multivariate logistic regression.ResultsA total of 507 participants were included in the study, with 361 (71.2%) being male. In terms of education, 125 (24.7%) had a junior high school level or below. The mean scores for knowledge, attitudes, and practices were 31.28 ± 7.30 (possible range: 0-42), 54.09 ± 3.33 (possible range: 12-60), and 35.48 ± 3.36 (possible range: 11-55), respectively. For specific knowledge items on CHD, 57.6% of participants correctly identified that women are more susceptible to CHD. Physical labor and emotional excitement as triggers for CHD were correctly recognized by 94.1%. The need for long-term medication and follow-up after a CHD diagnosis had the highest correctness rate at 98.8%. Additionally, 84.6% correctly understood that recurrence of CHD is possible after PCI surgery. Multivariate analysis indicated that smoking and diabetes status were significantly associated with Practice scores. Current smokers reported lower practice levels than never smokers (OR = 2.858, 95% CI: 1.442-5.662, P = 0.003). Participants with diabetes reported higher practice levels than those without diabetes (OR = 4.169, 95% CI: 2.329-7.463, P < 0.001).ConclusionsPatients with CHD in Shanghai, China, demonstrated good knowledge and positive attitudes toward CHD secondary prevention, although there were some gaps in actual practice behaviors. Enhancing targeted educational interventions and support systems in clinical settings may help bridge these gaps and improve adherence to recommended preventive practices.

Dataset Information

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

Objective

Design

Eligibility and criteria for selecting studies

Data extraction

Results

Conclusions

Publications

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

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