Has the association between saturated fatty acids, serum cholesterol and coronary heart disease been over emphasized?

Despite 50 years of research and public health messages, coronary heart disease is still the major cause of death in developed countries. This review outlines the elaboration of risk factors for coronary heart disease with emphasis on total and LDL cholesterol levels and discusses the dynamic and heterogeneous nature of serum lipoproteins. The role of saturated fatty acids in hypercholesterolemia is examined and it is concluded that those acids that increase levels concomitantly increase antiatherogenic HDL cholesterol and decrease proatherogenic lipoprotein[a] and small dense LDL particles such that they could be atherogenically neutral. Evidence from epidemiological studies does not supply convincing evidence for an association between saturated fatty acids and coronary heart disease. The surprisingly few randomised controlled trials that examined isocaloric substitution of saturated fatty acids for vegetable-derived fats mostly fail to show a benefit for reduction in saturated fatty acid intake on coronary heart disease risk. The contention that the benefits accruing from the potent hypocholesterolemic action of statin drugs ends the cholesterol controversy is disputed.