TY - JOUR T1 - Effects of dietary fats on blood lipids: a review of direct comparison trials JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2018-000871 VL - 5 IS - 2 SP - e000871 AU - James J DiNicolantonio AU - James H O’Keefe Y1 - 2018/07/01 UR - http://openheart.bmj.com/content/5/2/e000871.abstract N2 - Saturated fat has been demonised as a dietary culprit in heart disease due to its ability to raise low-density lipoprotein cholesterol (LDL-C), whereas omega-6 polyunsaturated fatty acid (PUFA) has been regarded as heart healthy due to its ability to lower total and LDL-C. And replacing saturated fat with omega-6 has consistently been found to lower total cholesterol and LDL-C levels.1 2 This has been the cornerstone for the belief that the omega-6 PUFA linoleic acid is heart healthy. However, the changes in LDL-C do not take into account the overall changes in the entire lipoprotein profile. For example, saturated fat appears to decrease small-dense LDL (sdLDL) and increase large buoyant LDL.3 As a high concentration of sdLDL and a low concentration of large buoyant LDL is associated with an increased risk of coronary heart disease (CHD),4 saturated fat may not necessarily increase the risk of CHD. Furthermore, compared with LDL-C, sdLDL (and oxidised LDL) seem to have a greater impact on atherosclerosis and cardiovascular disease.5 While saturated fat (particularly lauric acid) has been shown to increase total and LDL-C, there is also an increase in high-density lipoprotein cholesterol (HDL-C).6 Moreover, unsaturated fatty acids have a less prominent effect for increasing HDL-C compared with saturated fat. Thus, it is hard to interpret the overall risk of consuming foods high in saturated fat versus omega-6 PUFA when the former may improve sdLDL and HDL-C, whereas the latter may lower LDL-C but increases LDL susceptibility to oxidation and may lower HDL-C.7 8 Indeed, high concentrations of HDL-C are associated with greater protection from coronary artery disease and other cardiovascular diseases.9 10 Thus, the overall effect on the lipoprotein profile must be considered when assessing cardiovascular risk with dietary fats and fatty acids.The effects of replacing saturated fat … ER -