In a recent examination of the main tenets of the widely accepted diet
-heart disease hypothesis, Atrens concluded that the evidence to date
is not sufficient to support the hypothesis. Reviewing Atrens' critiqu
e highlights both strengths and limitations in his case against the ro
le of dietary lipids and cholesterol in coronary heart disease mortali
ty. Research on the following hypothesized relationships is discussed
in light of the objections raised by Atrens: the relationships between
fat intake and heart disease mortality; dietary fat and serum cholest
erol; serum cholesterol and atherosclerosis; atherosclerosis and heart
disease death; and serum cholesterol and heart disease death. The inc
onsistency of the findings suggests that definitive answers regarding
the diet-heart disease hypothesis are premature and that the polarized
positions of acceptance vs rejection of the hypothesis fail to accoun
t for the full range of results. Copyright (C) 1996 Elsevier Science L
td