• Rajiv Chowdhury, Samantha Warnakula, Setor Kunutsor, Francesca Crowe, Heather A Ward, Laura Johnson, Oscar H Franco, Adam S Butterworth, Nita G Forouhi, Simon G Thompson, Kay-Tee Khaw, Dariush Mozaffarian, John Danesh, and Emanuele Di Angelantonio.
• Ann. Intern. Med. 2014 Mar 18; 160 (6): 398406398-406.

BackgroundGuidelines advocate changes in fatty acid consumption to promote cardiovascular health.PurposeTo summarize evidence about associations between fatty acids and coronary disease.Data SourcesMEDLINE, Science Citation Index, and Cochrane Central Register of Controlled Trials through July 2013.Study SelectionProspective, observational studies and randomized, controlled trials.Data ExtractionInvestigators extracted data about study characteristics and assessed study biases.Data SynthesisThere were 32 observational studies (530,525 participants) of fatty acids from dietary intake; 17 observational studies (25,721 participants) of fatty acid biomarkers; and 27 randomized, controlled trials (103,052 participants) of fatty acid supplementation. In observational studies, relative risks for coronary disease were 1.02 (95% CI, 0.97 to 1.07) for saturated, 0.99 (CI, 0.89 to 1.09) for monounsaturated, 0.93 (CI, 0.84 to 1.02) for long-chain ω-3 polyunsaturated, 1.01 (CI, 0.96 to 1.07) for ω-6 polyunsaturated, and 1.16 (CI, 1.06 to 1.27) for trans fatty acids when the top and bottom thirds of baseline dietary fatty acid intake were compared. Corresponding estimates for circulating fatty acids were 1.06 (CI, 0.86 to 1.30), 1.06 (CI, 0.97 to 1.17), 0.84 (CI, 0.63 to 1.11), 0.94 (CI, 0.84 to 1.06), and 1.05 (CI, 0.76 to 1.44), respectively. There was heterogeneity of the associations among individual circulating fatty acids and coronary disease. In randomized, controlled trials, relative risks for coronary disease were 0.97 (CI, 0.69 to 1.36) for α-linolenic, 0.94 (CI, 0.86 to 1.03) for long-chain ω-3 polyunsaturated, and 0.89 (CI, 0.71 to 1.12) for ω-6 polyunsaturated fatty acid supplementations.LimitationPotential biases from preferential publication and selective reporting.ConclusionCurrent evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.Primary Funding SourceBritish Heart Foundation, Medical Research Council, Cambridge National Institute for Health Research Biomedical Research Centre, and Gates Cambridge.

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