Earlier positive findings and recent promising epidemiological data have been substantially challenged by RCTs of FSO in atherosclerosis. Following earlier positive outcomes in cardiovascular disease trials with whole flaxseed, a 1999 study showed that a low-ALA variety could produce comparable results with the earlier trials, suggesting that the antiatherogenic properties of flaxseed are independent of its ALA content (Prasad 1999).

More recent large-scale epidemiological studies continue to suggest a relationship between higher ALA intake and reduced coronary artery calcification (Djousse et al 2005); however, there is ongoing criticism that important variables have not been sufficiently accounted for, such as corresponding reductions in frans-FAs (Harris 2005, Wilkinson et al 2005).

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