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. 2023 Jan 28;13:1614. doi: 10.1038/s41598-023-28738-2

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Suggestions for future randomised controlled trials (RCTs) investigating dietary polyunsaturated fatty acids (PUFAs) on heart disease mortality. Available RCTs suggest that dietary PUFAs may not protect against heart disease mortality overall. However, those trials used high doses of dietary PUFAs, which do not likely mimic diet in the general public, and the high doses of dietary PUFAs used in many RCTs might have toxic effects. Some meta-analysis reports showed that increasing dietary intake of PUFAs in RCTs failed to show protection against heart disease mortality. Our results showed that, in people from the general public who did not have a prior diagnosis of myocardial infarction (MI), those with PUFA intake in the highest quartile had a 13% lower heart disease mortality risk compared to those in the lowest quartile. Future RCTs could target those without established coronary heart disease and with low dietary PUFA intake, with the intervention to increase PUFA intake to more modest levels (e.g., 10–11%, equivalent to the mean level in the highest quartile of our study).