Saturated fats and cardiovascular health: Current evidence and controversies

J Clin Lipidol. 2021 Nov-Dec;15(6):765-772. doi: 10.1016/j.jacl.2021.09.049. Epub 2021 Oct 1.


A diet high in saturated fatty acids (SFA) is a suspected contributor to atherosclerotic cardiovascular disease (ASCVD) risk, in large part because of an effect to raise the low-density lipoprotein cholesterol (LDL-C) concentration. Most dietary guidance from health authorities advocates limiting intake of SFA, particularly for people with clinical ASCVD, dyslipidemia, or diabetes mellitus. However, recent reviews have highlighted controversies regarding SFA intake and cardiovascular health. This brief editorial commentary includes a discussion of the evidence regarding SFA intake and cardiovascular health, outlines gaps in the available evidence, and proposes tentative conclusions based on what is known today about SFA consumption and ASCVD risk. Results from observational studies demonstrate that dietary patterns with lower average intakes of SFA are associated with favorable cardiovascular outcomes. Additionally, although the number of randomized controlled trials testing the effects of reducing SFA intake on ASCVD outcomes is limited, the available evidence supports the view that replacing SFA with unsaturated fatty acids, particularly polyunsaturated fatty acids, may reduce ASCVD risk. Beyond raising LDL-C and atherogenic lipoprotein particle concentrations, higher intakes of SFA may influence pathways affecting inflammation, cardiac rhythm, hemostasis, apolipoprotein CIII production, and high-density lipoprotein function. However, the impacts of these effects on ASCVD risk remain uncertain. In the authors' view, the totality of the evidence supports the current recommendation to limit SFA intake to <10% of total daily energy for the general healthy population and further (e.g., to 5-6% of total daily energy) for patients with hypercholesterolemia.

Keywords: Atherosclerotic cardiovascular disease; Cardiovascular health; Cardiovascular outcomes; Dietary guidelines; Lipoprotein lipids; Saturated fatty acids.

Publication types

  • Editorial

MeSH terms

  • Apolipoproteins B / metabolism
  • Atherosclerosis / diagnosis*
  • Atherosclerosis / etiology
  • Biomarkers / metabolism
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / etiology
  • Cardiovascular System / drug effects
  • Cardiovascular System / metabolism*
  • Cholesterol, LDL / metabolism
  • Dietary Fats / administration & dosage
  • Dietary Fats / adverse effects
  • Fatty Acids / administration & dosage*
  • Fatty Acids / adverse effects
  • Humans
  • Lipoproteins, HDL / metabolism
  • Risk Factors


  • Apolipoproteins B
  • Biomarkers
  • Cholesterol, LDL
  • Dietary Fats
  • Fatty Acids
  • Lipoproteins, HDL