Cochrane for Clinicians

Putting Evidence into Practice

Reducing Saturated Fat Intake to Decrease the Risk of Cardiovascular Disease


Am Fam Physician. 2021 Sep ;104(2):235-236.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does reducing saturated fat intake decrease morbidity and mortality related to cardiovascular disease (CVD)?

Evidence-Based Answer

Reducing saturated fat in the diet for at least two years decreases the risk of combined cardiovascular events (relative risk [RR] = 0.83; 95% CI, 0.70 to 0.98; number needed to treat [NNT] for primary prevention = 56). However, there is little to no effect on cardiovascular mortality, all-cause mortality, or individual cardiovascular events.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

CVD continues to be the leading cause of death in the United States and worldwide.2,3 Up to one-third of deaths globally are directly attributable to CVD, 85% of which are associated with heart disease and stroke. In the United States, heart disease is consistently the leading cause of death, and stroke is currently the fifth. The American Heart Association estimates that 45% of the U.S. population will have some form of CVD by 2035.4 As of 2016, more than 10.3% of primary care visits have been related to CVD, and up to 55% of visits include management of CVD risk factors (e.g., hypertension, dyslipidemia, diabetes mellitus).4 In an effort to determine the role of diet in CVD prevention, this review assessed if reducing saturated fat intake resulted in decreased cardiovascular morbidity and mortality.

This Cochrane review included 15 randomized controlled trials (RCTs) published between 1965 and 2019 that involved 56,675 adults 46 to 66 years of age.1 Participants were living in developed nations of North America, Europe, and Australia/New Zealand and had varied levels of CVD risk. They were followed for an average of 4.7 years (range = 2 to 8 years). The largest study was the 2006 Women's Health Initiative, involving 29,294 women; sensitivity analyses excluding this study did not alter the major findings of this review, as outlined below. Blinding of study participants was

Author disclosure: No relevant financial affiliations.


show all references

1. Hooper L, Martin N, Jimoh OF, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;(8):CD011737....

2. Heron M. Deaths: leading causes for 2017. National Vital Statistics Reports, vol. 68, no. 6. National Center for Health Statistics; 2019. Accessed August 2, 2021.

3. World Health Organization. Cardiovascular diseases (CVDs). May 17, 2017. Accessed August 11, 2021.

4. Virani SS, Alonso A, Benjamin EJ, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–e596.

5. Carson JS, Lichtenstein AH, Anderson CAM, et al.; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Peripheral Vascular Disease; and Stroke Council. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2020;141(3):e39–e53.

6. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th ed. December 2015. Accessed December 14, 2020.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at



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