title: Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73).
abstract: OBJECTIVE
  To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis.
  
  
  METHODS
  The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and death by lowering serum cholesterol. Recovered MCE unpublished documents and raw data were analyzed according to hypotheses prespecified by original investigators. Further, a systematic review and meta-analyses of randomized controlled trials that lowered serum cholesterol by providing vegetable oil rich in linoleic acid in place of saturated fat without confounding by concomitant interventions was conducted.
  
  
  METHODS
  One nursing home and six state mental hospitals in Minnesota, United States.
  
  
  METHODS
  Unpublished documents with completed analyses for the randomized cohort of 9423 women and men aged 20-97; longitudinal data on serum cholesterol for the 2355 participants exposed to the study diets for a year or more; 149 completed autopsy files.
  
  
  METHODS
  Serum cholesterol lowering diet that replaced saturated fat with linoleic acid (from corn oil and corn oil polyunsaturated margarine). Control diet was high in saturated fat from animal fats, common margarines, and shortenings.
  
  
  METHODS
  Death from all causes; association between changes in serum cholesterol and death; and coronary atherosclerosis and myocardial infarcts detected at autopsy.
  
  
  RESULTS
  The intervention group had significant reduction in serum cholesterol compared with controls (mean change from baseline -13.8%v-1.0%; P<0.001). Kaplan Meier graphs showed no mortality benefit for the intervention group in the full randomized cohort or for any prespecified subgroup. There was a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol in covariate adjusted Cox regression models (hazard ratio 1.22, 95% confidence interval 1.14 to 1.32; P<0.001). There was no evidence of benefit in the intervention group for coronary atherosclerosis or myocardial infarcts. Systematic review identified five randomized controlled trials for inclusion (n=10,808). In meta-analyses, these cholesterol lowering interventions showed no evidence of benefit on mortality from coronary heart disease (1.13, 0.83 to 1.54) or all cause mortality (1.07, 0.90 to 1.27).
  
  
  CONCLUSIONS
  Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.
authors.affiliation: Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA Chris.Ramsden@nih.gov.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Ramsden
authors.affiliation: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Daisy
authors.initials: D
authors.lastname: Zamora
authors.affiliation: Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Majchrzak-Hong
authors.affiliation: Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Keturah R
authors.initials: KR
authors.lastname: Faurot
authors.affiliation: Medtronic, Minneapolis, MN, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Broste
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Frantz
authors.affiliation: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Davis
authors.affiliation: Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Ringel
authors.affiliation: Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Chirayath M
authors.initials: CM
authors.lastname: Suchindran
authors.affiliation: Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hibbeln
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood*; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D003327:Coronary Disease / Q000097:blood / Q000178:diet therapy* / Q000209:etiology / Q000517:prevention & control; D018752:Diet, Fat-Restricted / Q000379:methods*; D004041:Dietary Fats / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D049673:History, 20th Century; D006801:Humans; D053208:Kaplan-Meier Estimate; D019787:Linoleic Acid / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D010938:Plant Oils / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic / Q000266:history; D012307:Risk Factors; D055815:Young Adult
chemical_list: D004041:Dietary Fats; D010938:Plant Oils; D002784:Cholesterol; D019787:Linoleic Acid