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The Diet-Heart Hypothesis: a critical appraisal of the relationship between diet and coronary artery disease


Abstract: The role of proper diet in cardiovascular health is one which has been heavily debated over the last century. In 1908, Ignatowski produced atherosclerotic lesions in rabbits with a diet high in cholesterol and saturated fat. He subsequently fed the rabbits cholesterol alone, which produced identical lesions (1). During the early 1950s, controlled feeding studies showed that saturated fatty acids and, to a smaller extent, dietary cholesterol increased serum cholesterol in human subjects (2). Later, epidemiologic studies found that increases in serum cholesterol predicted increased risk of coronary artery disease (CAD) in humans. These findings led to the development of the ‘diet-heart hypothesis’, which assumes a primary role of dietary saturated fat and cholesterol in the causation of atherosclerosis and CAD. Currently, the relationship between high serum cholesterol and CAD is well established, however, the role of diet in both the prevention and treatment of CAD remains controversial. Utilizing the medical literature, 3 dietary tenets have been established which are strongly associated with decreased risk of coronary artery disease: Consumption of good fatty acids (polyunsaturated fats, omega-3 fatty acids), multiple fruits and vegetables, and non-refined whole grains.

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