Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk
Authors: Frank Davidoff, Irwin H. Rosenberg
Journal: Annals of Internal Medicine (2014)

Letters16 September 2014Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary RiskFrank Davidoff, MD and Irwin H. Rosenberg, MDFrank Davidoff, MDFrom Dartmouth College, Wethersfield, Connecticut; and Tufts University, Medford, Massachusetts.Search for more papers by this author and Irwin H. Rosenberg, MDFrom Dartmouth College, Wethersfield, Connecticut; and Tufts University, Medford, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L14-5018-3 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The review by Chowdhury and colleagues (1) provides a sobering reappraisal of the widely presumed association between dietary fat and coronary disease. Unfortunately, their otherwise careful analysis uncritically accepts the assumption that the size of an intervention's effect in individual members (or subgroups) of a study population is the same as that of the entire study population; that is, the review fails to avoid the ecological fallacy.Kent and coauthors (2) identify 2 potentially serious clinical consequences of ignoring the ecological fallacy. Both are due to the inherent risk-based heterogeneity of absolute treatment effects (3), which has ...References1. Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med. 2014;160:398-406. [PMID: 24723079] doi:10.7326/M13-1788 LinkGoogle Scholar2. Kent DM, Rothwell PM, Ioannidis JP, Altman DG, Hayward RA. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal. Trials. 2010;11:85. [PMID: 20704705] doi:10.1186/1745-6215-11-85 CrossrefMedlineGoogle Scholar3. Davidoff F. Heterogeneity is not always noise: lessons from improvement. JAMA. 2009;302:2580-6. [PMID: 20009058] doi:10.1001/jama.2009.1845 CrossrefMedlineGoogle Scholar4. Hayward RA, Kent DM, Vijan S, Hofer TP. Reporting clinical trial results to inform providers, payers, and consumers. Health Aff (Millwood). 2005;24:1571-81. [PMID: 16284031] CrossrefMedlineGoogle Scholar5. Kovalchik SA, Tammemagi M, Berg CD, Caporaso NE, Riley TL, Korch M, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med. 2013;369:245-54. [PMID: 23863051] doi:10.1056/NEJMoa1301851 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Frank Davidoff, MD; Irwin H. Rosenberg, MDAffiliations: From Dartmouth College, Wethersfield, Connecticut; and Tufts University, Medford, Massachusetts.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0323. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Rajiv Chowdhury , Samantha Warnakula , Setor Kunutsor , Francesca Crowe , Heather A. Ward , Laura Johnson , Oscar H. Franco , Adam S. Butterworth , Nita G. Forouhi , Simon G. Thompson , Kay-Tee Khaw , Dariush Mozaffarian , John Danesh , and Emanuele Di Angelantonio Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Rajiv Chowdhury , Samantha Warnakula , Setor Kunutsor , Francesca Crowe , Heather A. Ward , Laura Johnson , Oscar H. Franco , Adam S. Butterworth , Nita G. Forouhi , Simon G. Thompson , Kay-Tee Khaw , Dariush Mozaffarian , John Danesh , and Emanuele Di Angelantonio Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Christine Dawczynski , Marcus E. Kleber , Winfried März , Gerhard Jahreis , and Stefan Lorkowski Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Bonnie F. Liebman , Martijn B. Katan , and Michael F. Jacobson Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Lisa Te Morenga , Jim Mann , and Murray Skeaff Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Lukas Schwingshackl and Georg Hoffmann Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Mark McCaulley Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Connie Diekman , Gerard Hornstra , Bethold V. Koletzko , Anna Lartey , and Joyce Nettleton Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Johanna M. Geleijnse , Ingeborg A. Brouwer , and Daan Kromhout Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Adrienne O’Neil and Catherine Itsiopoulos Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Emanuele Di Angelantonio , Rajiv Chowdhury , Nita G. Forouhi , and John Danesh Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Adrienne O’Neil and Catherine Itsiopoulos Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Walter C. Willett , Meir J. Stampfer , and Frank M. Sacks Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Emanuele Di Angelantonio , Rajiv Chowdhury , Nita G. Forouhi , and John Danesh Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Christine Dawczynski , Marcus E. Kleber , Winfried März , Gerhard Jahreis , and Stefan Lorkowski Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Johanna M. Geleijnse , Ingeborg A. Brouwer , and Daan Kromhout Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Mark McCaulley Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Bonnie F. Liebman , Martijn B. Katan , and Michael F. Jacobson Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Lisa Te Morenga , Jim Mann , and Murray Skeaff Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Lukas Schwingshackl and Georg Hoffmann Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk Connie Diekman , Gerard Hornstra , Bethold V. Koletzko , Anna Lartey , and Joyce Nettleton Metrics Cited byNew Insights or Confusion—Is Butter Really Back? 16 September 2014Volume 161, Issue 6Page: 454KeywordsAspirinAtrial fibrillationCancer screeningDisclosureDrug therapyFatsFatty acidsMedical risk factorsStroke ePublished: 16 September 2014 Issue Published: 16 September 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...