Saturated fat intake has been associated with the risk of cardiovascular disease (CVD). This review focuses on the effect of replacing saturated fat intake by other macronutrients on CVD risk. Much controversy remains concerning the replacement of saturated fat by polyunsaturated fat in randomized controlled clinical trials, but several studies reported a reduced CVD risk. On the other hand, substitution of saturated fat for carbohydrates is not recommended since the high glycemic load from refined carbohydrates has also been shown to be associated with an increased risk of coronary heart disease (CHD) by inducing an atherogenic dyslipidemia. The authors proposed that dietary recommendations for CVD prevention and treatment should take into consideration the changes observed in CVD risk factors in the context of the obesity epidemic and limit the substitution of saturated fat by refined carbohydrates. In his comment, Jeremiah Stamler was a harsh critic of the article of Siri-Tarino and colleagues. He listed and commented 12 questions which he considered were not addressed by the authors. He blamed the authors of being inaccurate in their interpretation of the literature as well as for not considering the influence of dietary cholesterol in their analysis. Moreover, he discussed the extensive 50-year history of diet-heart studies which have generated extensive findings and dietary recommendations for prevention of CHD/CVD risk which did not seem to be considered in the current study.
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