11 e-Letters

  • Response to CardioBrief blog post

    Clinical practice has been historically driven by evidence-based medicine. Properly sized randomized controlled trials have been the basis of accepting or rejecting research hypotheses, and clinical guidelines are developed based on data reported in such trials. Clinical research is not perfect. However, most clinical trials are conducted in a highly regulated environment and accepted for publication following a strict peer review process led by independent experts. While limitations exist in conducting and reporting clinical trials, investigators are judged at very high ethical and academic standards.

    A blog posted on September 11, 2017[1] questioned the integrity of the data and ethical conduct of the investigators of this study published in Open Heart. Due to the respect I have for the editor and this journal, I am obliged to respond on behalf of the authors.

    First, I did not receive ANY type of financial compensation as the principal investigator for this study. Second, no financial obligations or equity arrangements exist between the sponsor of the study, myself or my current Institution. Third, although all financial disclosures of all authors were properly disclosed to the journal at the time of submission, they were unfortunately not included in the final published article and therefore published subsequently as a correction[2]. Fourth, the objective of the study was to assess the 3-week healing properties of a surface-modified stent. The patient wi...

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  • India is struggling under a staggering burden of chronic disease
    David E. Brown

    The citizenry of India are especially sensitive to excessive linoleic acid intake as noted by S. L. Malhotra in a research paper published back in 1967. Excerpt: "Much evidence indicates that consumption of even small quantities of unsaturated fatty acids decreases the liability to ischaemic heart disease (Bronte-Stewart et al., 1956; Kinsell et al., 1952). This hypothesis, too, does not find support in our data. The South...

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  • Re: Evidence from RCTs did not support introduction of dietary fat guidelines in 1977 & 1983
    Vivien S. Lund

    Dietary advice that reducing fat and saturated fat consumption will reduce the risk of coronary heart disease was introduced in the UK in 1983. The authors of this systematic review and meta-analysis conclude that evidence from randomised controlled trials, available at the time, did not support that advice.

    It is important to highlight that the review looks at the results of just six relatively short-term ra...

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  • Randomised controlled trials and diet-heart recommendations
    Christine M Williams

    Re: Harcombe et al. Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983:

    The claim made by the authors of this paper that guidelines on dietary fat introduced in the 1970s and 1980s were not based on good scientific evidence is misguided and potentially dangerous. Whilst it is important to ensure an ongoing interrogation of the evidence linking d...

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  • Re:Letter to the Editor: Evidence from randomised controlled trials not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis
    Zoe Harcombe

    We would like to thank you for your interesting and helpful comments.

    We are currently finalising the follow-up paper, which is to consider all RCT evidence for current dietary guidelines before and since their introduction, to see if they have been supported in hindsight. We will review the risk of bias assessment tool, as suggested.

    We do accept the role that cohort studies can play but wanted to focu...

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  • Letter to the Editor: Evidence from randomised controlled trials not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis
    Lukas Schwingshackl

    With great interest we read the meta-analysis of Harcombe and co- workers titled "Evidence from randomized controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis" published in volume 2 of the Open Heart Journal [1]. In their article, the authors systematically reviewed randomized controlled trials investigating the associations between dietary fa...

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  • Fascinating: So it was basically a political decision
    David J Unwin

    At last I know how these damaging and pernicious guidelines came about. They introduced a dark age of medicine and dogma that continues to effect my practice.

    How I struggle to get patients to accept eggs and butter as part of a healthy diet . It's my belief that sugar and other carbohydrates are the real problem.

    I have seen great results for 70 patients in my practice with the metabolic syndrome usi...

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  • More contradictions to the dietary guidelines
    Uffe Ravnskov

    Hopefully the meta-analysis by Harcombe et al. (1) may inspire the authorities to correct their dietary recommendations, because other studies have shown that the intake of saturated fatty acids (SFA) does not increase the risk of cardiovascular disease.

    Not only did the authors of the dietary guideline from 1977 and 1983 ignore the dietary trials; they also ignored several unsupportive cohort studies. Before 1...

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  • Though commonly missed, however exceedingly important
    Rajeev Gupta

    Dear Sir:

    The data is accumulating to show the adverse outcomes in critically sick patients with persistently elevated troponins. An elegant study by Amman et al (1) in 58 critically ill patients without acute coronary syndromes concluded "Positive troponin levels were associated with higher mortality (22.4% vs. 5.2%, p < 0.018) and a lower LVEF (p = 0.0006). Troponin-positive patients had significantly high...

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  • Cardiovascular disease 1 - 0 Diabesity
    Philip D Thompson

    The current dietary guidelines are strongly associated (at least temporally) with an exponential growth in obesity and Type 2 diabetes. These unintended consequences may have arisen due to increased consumption of carbohydrate in order to reduce fat in the diet.

    If the guidelines cannot rely on a solid basis of science then they should be withdrawn and re-written. There is a precedent - we no longer have limits...

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