Table 1.

Summary of studies related to fats and CVD.

Author	Type of Study	Purpose	Included	Conclusion
[11]	Meta-Analysis of prospective epidemiological studies	21 studies related to the association of dietary saturated fat with CHD, stroke, CVD; CHD inclusive of stroke.	5–23 years of follow-up of 347,747 subjects	No significant evidence that saturated fat is associated with increased risk of CHD or CVD
[41]	Epidemiological Cohort	Associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality.	Dietary intake of 135,335 individuals aged 35–70 years, in 18 countries; median follow-up 74 years,	↑ Carbohydrate intake associated with ↑ risk of total mortality; total fat and types of fat related to ↓ total mortality. Total fat and types of fat not associated with CVD, myocardial infarction, or cardiovascular disease mortality, saturated fat had an inverse association with stroke.
[22]	Prospective Cohort	Associations between intakes of individual SFAs and their food sources in relation to the risk of CHD.	80,082 women aged 34–59 Nurse’s Health Study; 14-year follow up	Short- to medium-chain fats not associated with CHD risk; intake of longer chain = ↑ risk; ratio of PUFA to SFA inversely associated with CHD risk.
[14]	Meta-Analysis of observational studies	Associations between intake of saturated fat and trans unsaturated fat and all cause mortality, CVD and associated mortality, CHD and associated mortality, ischemic stroke, and type 2 diabetes.	41 studies on saturated fats and health outcomes in prospective cohort studies published between 1981 and 2014; 67 data points; 20 studies with 28 data points for trans fats	Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality.
[23]	Prospective Cohort	Associations of SFAs compared to PUFAs and carbohydrates to CHD risk.	84,628 women 42,908 men 24–30 year follow up	↑ Intake of PUFAs and whole grains = ↓ risk of CHD; replacing 5% of energy intake from SFAs with PUFAs, MUFAs, or carbohydrates from whole grains was associated with a 25%, 15%, and 9% ↓ risk of CHD.
[42]	Prospective Cohort	Association between fat intake and CHD.	43,757 men aged 40 to 75 years; 6 year follow up	SFA intake not associated with CHD once corrected for fiber intake; ↑ linolenic acid = ↓ risk CHD.
[43]	Prospective Cohort	Association between dietary SFA and CHD depends on the food source, the carbon chain length of SFA, and the substituting macronutrient.	4722 Dutch men and women > 55 years; 16.3 year follow up	↑ Intake of palmitic acid ↑ risk; other SFAs are not associated with CHD; no effect of food source of SFA; replacement of SFA with animal protein ↑ risk; replacement with other macronutrients not associated with risk.
[44]	Prospective Cohort and Meta-Analysis	Association between carbohydrate intake and mortality.	15,428 aged 55–64 years ARIC study; 25 year follow up	U-shaped relationship between carbohydrate intake and mortality; low carbohydrate intake with animal protein increased risk, while with high plant protein decreased risk.
[45]	Prospective population study	Association of macronutrient intake with all cause mortality and CVD, and the implications for dietary advice.	195,658 adults 10.6 year follow up	Carbohydrate intake > 50% ↑ association with mortality; ↑ intake of MUFA, ↓ intake of PUFA, ↓ intake of SFA = ↓ risk of mortality.
[46]	Systematic Review and Meta-Analysis of RCTs	Assess the impact of phytosterol (PS) supplementation on serum Lp(a) and FFA concentration.	12 effect sizes from 7 different studies	PS supplementation = ↓ in Lp(a) and FFA.
[37]	Systematic Review and Meta-Analysis	Examine the evidence surrounding coconut oil consumption and its impact on cardiovascular health.	12 studies	Compared with plant oils and animal oils, coconut oil ↑ HDL-C by 0.57 mg/dL and 0.33 mg/dL. Coconut oil significantly ↑ LDL-C by 0.26 mg/dL compared with plant oils and ↓ LDL-C (48.1%) compared with animal oils. No effects on triglyceride. Better lipid profiles were demonstrated with the virgin form of coconut oil.
[49]	Prospective Cohort	Association between coconut oil intake and plasma lipid profiles.	1896 Filipino women aged 35–69 years	In pre-menopausal women, dietary coconut oil use was associated with TC and HDL-C, not in post-menopausal women; coconut oil did not elevate TC, triglyceride levels, and TC/HDL.
[47]	RCT	Compare changes in blood lipid profile, weight, fat distribution, and metabolic markers after four weeks of consumption of 50 g daily of extra virgin coconut oil, butter, or extra virgin olive oil.	91 men and women	LDL-C significantly increased on butter compared with coconut oil and with olive oil, no differences in change of LDL-C in coconut oil compared with olive oil. Coconut oil significantly increased HDL-C compared with butter or olive oil. Butter significantly increased TC/HDL-C ratio and non-HDL-C compared with coconut oil, while coconut oil did not significantly differ from olive oil for TC/HDL-C and non-HDL-C. No significant differences in changes in weight, BMI, central adiposity, fasting blood glucose, and systolic or diastolic blood pressure in any group.
[50]	RCT cross over	Compare the effects of coconut oil, butter, and safflower oil on lipids and lipoproteins of moderately hypercholesterolemic subjects.	13 men and 15 women with a plasma total cholesterol between 5.5 and 7.9 mmol/L and plasma triacylglycerols (TAG) less than 3 mmol/L consumed 50% of fat from butter, coconut oil, or safflower oil	Coconut oil and butter diets increased TC and LDL-C compared to safflower oil; the levels of both were significantly lower in the coconut oil than on the butter diet.
[51]	Systematic Review and Meta-Analysis	A systematic review of the effect of coconut oil consumption on blood lipids and other cardiovascular risk factors compared with other cooking oils using data from clinical trials.	16 articles included in the meta-analysis	Coconut oil increased LDL-cholesterol by 10.47 mg/dL and HDL-cholesterol by 4.00 mg/dL compared with nontropical vegetable oils. Coconut oil consumption did not significantly affect markers of glycemia, inflammation, and adiposity as compared with nontropical vegetable oils.
[52]	Systematic Review and Network meta-Analysis	Compare the effects of different oils/solid fats on blood lipids.	54 RCTs 2065 subjects included	Safflower oil ↓ in TC and LDL-C the most, followed by rapeseed oil and sunflower oil; soybean oil was the most effective oil to ↓ TG, followed by corn oil and palm oil; butter and lard were ranked worst for TC and LDL-C reduction; coconut oil was ranked best to ↑ HDL-C, followed by palm oil and beef fat. The NMA showed that all vegetable oils were more effective in reducing TC and LDL-C compared with butter.