Dietary Prevention of Coronary Heart Disease: Long-Term Experiment

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Abstract
The feasibility of primary prevention of coronary heart disease by dietary means was studied in two mental hospitals. In one of them the diet was changed so that most of the milk fat was replaced by soybean oil, whereas rise other hospital was kept as the control without any intentional dietary change. After this change the diet in the experimental hospital contained much more polyunsaturated fatty acids and much less saturated fatty acids than that of the control hospital. Male patients, from 34 to 64 years in age, initially, constituted the groups examined. The total number of subjects studied was 327 in the experimental hospital and 254 in the control hospital. The phase of the study reported here lasted 6 years and 2 months. A fall in the serum cholesterol level occurred after the dietary change. During the following period of study the serum cholesterol in the experimental hospital was, on the average, 51 mg/dl lower than in the control hospital. The serum triglycerides and phospholipids were also lower in the experimental hospital. After 5 years on the respective diets the adipose tissue of the subjects of the experimental hospital contained much more linoleic and linolenic acids and much less myristic acid than that of the subjects of the control hospital. The incidence of electrocardiographic patterns indicative of coronary heart disease was markedly and significantly lower in the experimental hospital. The coronary mortality also appeared to be lower in the experimental hospital, but the number of deaths was too small for statistically valid conclusions. The incidence of coronary heart disease assessed on the basis of both electrocardiographic changes and coronary mortality was significantly lower in the experimental hospital. An examination of the comparability of the two groups revealed differences in the two populations of reference and in some of the known risk factors, but these seemed insufficient to account for the rather marked difference in the incidence of coronary heart disease. Hence, it was concluded that the lower incidence in the experimental group was primarily due to the cholesterol-lowering special diet.