Dietary fat and other risk factors
High-fat diets lower fasting triacylglycerol concentrations, which
may reduce cardiovascular disease risk (85), but they also increase
postprandial concentrations of triacylglycerol-rich lipoproteins, which
are positively associated with CAD risk (100). In addition, the elevated
factor VII coagulant activity that occurs during the postprandial
phase of high-fat diets may predispose a person to coronary
thrombosis (101, 102). Whether a high-fat diet or a high-carbohydrate
diet changes insulin sensitivity or leads to the development of type 2
diabetes is still controversial (103). The final answer as to the overall
effect of cis unsaturated fatty acids and carbohydrates on CAD risk
can only be decided by long-term controlled clinical trials. Clinical
trials have indeed shown that the replacement of SFAs and trans fatty
acids with polyunsaturated oils reduces the incidence of CAD (104).
The few trials that studied replacement of SFAs with carbohydrates