Dietary fats and prevention of cardiovascular disease. Conclusion may have been underplayed.

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Editor—The paper by Hooper et al may fulfil the Cochrane review criteria for a meta-analysis of clinical trials, but it does not provide a systematic review of the issues relating to dietary fat intake and the prevention of cardiovascular disease.1 It is important to consider the overall appropriateness of each trial before its inclusion in a meta-analysis. Several of the trials included are small or of short duration. It is difficult to imagine how the risk of coronary heart disease that has accrued over a prolonged period may be reversed by dietary modification in less than two years. The diet and infarction trial (fat modification arm) contributed the greatest number of cardiovascular end points, yet there are at least two reasons why this trial was unlikely to show a beneficial effect. Limited dietary instruction was given, so there was little change in cholesterol concentrations. Since modification of fat quality produces a predictable average change in cholesterol, there was c

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