Anti-Coronary Club Trial

The New York Anti-Coronary Club

 In June 1957, the Diet and Coronary Heart Disease Study Project, popularly known asthe “Anti-coronary Club,” was established by the Bureau of Nutrition, New York CityDepartment of Health  (Jolliffe et al. 1959). One of the project leaders, George Christakis, a New York internist specializing in nutrition and metabolism, reported that they recruited by radio and newspaper 1,091 men ages 40-59, 814 of whom became “active” in the “club.” Two years later, in an apparent afterthought, they enlisted 463 men, volunteers from the city’s Cancer Detection Unit, as casual “controls” to be followed in parallel (Christakis et al. 1966).

The so-called controls had 20 mg/dl lower cholesterol levels at entry, in part because a greater percentage of them were younger. Meanwhile, the active diet group achieved a 30 mg/dl lowering in total serum cholesterol, which was well maintained for the five-year observation period. Eight men from the diet group experienced coronary events, compared with twelve in the non-randomized “controls”–a difference to which the investigators inappropriately applied statistical tests of significance.

Christakis’s conclusion that the trial achieved a “significantly decreased incidence of coronary heart disease” was not accepted by the scientific community, either by his colleagues newly occupied with epidemiology and trials, or by the growing U.S. company of clinical investigators. No more accepted was his claim that the Anti-coronary Club “appears to have established a reasonable basis for public health action” (ibid., 313). In his role as a skilled nutritionist, however, he was given credit for labeling the “prudent diet:” equal proportions of saturated, monounsaturated, and polyunsaturated fatty acids and 30 percent of total calories from fat, as well as for his free-living participants adherence to the diet and for the substantial blood cholesterol lowering achieved.

Christakis also made these cogent early arguments for recommendations to the general population:

We are, in fact, faced with the strong possibility that a diet pattern based on the principle of moderation in saturated fat consumption and which provides a varied, nutritionally sound diet while lowering serum cholesterol, may constitute a contribution to the development of a more physiologically optimal diet pattern for adults. The constituents of this diet are available from food markets everywhere, are palatable, fulfill the nutrient requirements of the National Research Council and are free of food fad characteristics(ibid., 312).

 

 

Ref. Christakis, G. A dietary approach to the prevention of coronary heart disease: A seven-year report.

(1966) Am. J. Public Health. Nations Health. 56(2): 299-314.