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The only significant finding in the original 2006 WHIRCDMT publication was that postmenopausal women with CHD randomised to a low-fat \u2018heart-healthy\u2019 diet in 1993 were at 26% greater risk of developing additional CHD events compared with women with CHD eating the control diet. A 2017 WHIRCDMT publication includes data for an additional 5 years of follow-up. It finds that CHD risk in this subgroup of postmenopausal women had increased further to 47%\u201361%. The authors present three post-hoc rationalisations to explain why this finding is \u2018inadmissible\u2019: (1) only women in this subgroup were less likely to adhere to the prescribed dietary intervention; (2) their failure to follow the intervention diet increased their CHD risk; and (3) only these women were more likely to not have received cholesterol-lowering drugs. These rationalisations appear spurious. Rather these findings are better explained as a direct consequence of postmenopausal women with features of insulin resistance (IR) eating a low-fat high-carbohydrate diet for 13 years. All the worst clinical features of IR, including type 2 diabetes mellitus (T2DM) in some, can be \u2018reversed\u2019 by the prescription of a high-fat low-carbohydrate diet. The Women\u2019s Health Study has recently reported that T2DM (10.71-fold increased risk) and other markers of IR including metabolic syndrome (6.09-fold increased risk) were the most powerful predictors of future CHD development in women; blood low-density lipoprotein-cholesterol concentration was a poor predictor (1.38-fold increased risk). These studies challenge the prescription of the low-fat high-carbohydrate heart-healthy diet, at least in postmenopausal women with IR, especially T2DM. According to the medical principle of \u2018first do no harm\u2019, this practice is now shown to be <jats:italic>not<\/jats:italic> evidence-based, making it scientifically unjustifiable, perhaps unethical.<\/jats:p>","DOI":"10.1136\/openhrt-2021-001680","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T12:56:08Z","timestamp":1626872168000},"page":"e001680","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Hiding unhealthy heart outcomes in a low-fat diet trial: the Women\u2019s Health Initiative Randomized Controlled Dietary Modification Trial finds that postmenopausal women with established coronary heart disease were at increased risk of an adverse outcome if they consumed a low-fat \u2018heart-healthy\u2019 diet"],"prefix":"10.1136","volume":"8","author":[{"given":"Timothy David","family":"Noakes","sequence":"first","affiliation":[{"name":"Applied Design, Cape Peninsula University of Technology, Bellville, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,21]]},"reference":[{"key":"2025081709582642000_8.2.e001680.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.6.655"},{"key":"2025081709582642000_8.2.e001680.2","unstructured":"Select Committee on Nutrition and Human Needs of the United States Senate . 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