Dietary fats in the prevention of coronary heart disease: the need for more clinical trials

Abstract

On the basis of various lines of evidence, including clinical trials, diet appears to have the potential to lessen the risk of CHD events, independent of effects on serum lipid values, at least as great as the most effective medical and interventional treatments available today. Given the diversity of these cardioprotective diets, as well as their salutary components, one of the priorities in research should be to undertake more comparative trials, trials which determine patient acceptability, effects on surrogate markers of risk, and which ultimately impact on morbidity and mortality. The Carolina Diet Heart Trial is a clinical outcome trial comparing two ‘proven’ cardioprotective diets, the AHA endorsed Step II diet versus an American-Mediterranean diet, and having the amount and type of unsaturated fat as the main dependent variable. This study is a protective, randomized, multi-centre, secondary prevention trial with the ultimate intention of reducing the incidence of subsequent cardiovascular events through dietary modification in patients who have survived a previous acute coronary syndrome. The study intervention is also designed to give these patients the necessary knowledge, motivation and practical ability to modify their current diets and maintain long-term adherence to a more cardioprotective diet. The initial pilot phase will assess compliance with the two study diets, as well as assess the impact of each diet on a marker of CHD risk.