Do trans fatty acids increase the risk of coronary artery disease? A critique of the epidemiologic evidence

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Abstract
On the basis of metabolic and epidemiologic data it has been claimed that trans fatty acid intake causes coronary artery disease (CAD), with > or = 30,000 deaths/y in the United States and a considerably greater number of nonfatal cases. The metabolic evidence is still controversial; the epidemiologic evidence is reviewed here. In most studies the likelihood that CAD "caused" margarine use, rather than the reverse, was not excluded. Uncontrolled confounding (particularly confounding by indication) was ubiquitous. Selection bias conditional on margarine use was common. The projection of 30,000 deaths/y is not justified. If the metabolic evidence, when fully evaluated, is deemed to be suggestive, then the question of whether trans fatty acids are indeed harmful to human populations will be resolved only by means of a randomized controlled trial.