Previous works showed that there were no difference in lipid profile (serum total cholesterol, triacylglycerols, and cholesterol in lipoprotein fractions) between persons taking coconut oil or sunflower oil. Higher intake of coconut oil did not cause any significant increase in the concentration of lauric acid in blood among coconut oil consumers.(6)  Moreover, serum lipid values did not show significant variation between animals (New Zealand white rabbits) fed coconut oil or sunflower oil. Coconut oil intake did not cause hypercholesterolemia or oxidative stress in rabbits.(7)  In another study, the fatty acid content of the coronary plaque (endartectomy specimen) did not show any difference between coconut oil consumers versus sunflower oil consumers.(8)  Since these studies were done in free living subjects many confounding factors like eating outside, quantity of oil, duration of consumption and physical activity were could not be assessed correctly.  Another large study involving 200 coronary artery disease patients on medical treatment with 2 yrs long follow up did not reveled any significant difference in anthropometry, lipid profile, vasomotor function, antioxidant levels and cardiac events at the end of 2 yrs.(10)

The main limitation of the studies involving human are 1) the lack of control over other nutrients which affect the serum lipids positively or negatively 2) non dietary factors like physical activity, life styles and the genomic factors are likely to Influence the outcomes 3) most of the physician driven small clinical studied included specialized patient population like coronary artery diseases or patient with diabetes mellitus  4) few of the data in humans using medium chain triglyceride are controversial as the commercially available MCT is different as it contain very small amount of lauric acid which is the main content in coconut oil hence it is difficult to extrapolate these results with coconut oil studies 5) small duration intervention with either coconut oil or virgin coconut oil is insufficient to test the hard outcomes of cardiovascular system as it requires a long time for the metabolites to produce a favourable or unfavourable effect 6) VCO is not tested in long term human clinical trials or observational studies7) most importantly the clinical hard end points death, myocardial infarction, stroke were not considered as end point in these studies

To have clarity on coconut oil’s effect (as dietary) on cardiovascular outcome we need a) long term longitudinal follow up study of a cohort or families without cardiovascular diseases or other comorbidities b) Globally accepted clinical as well as biochemical out comes should be monitored periodically c) can compare with one of other commonly used oil d) different ethnic population should be included in the study to assess genomic and epingenomic influences.

Such a study will definitely help the medical, scientific, heart-health, governmental and intergovernmental, and professional authorities to formulate the dietary recommendations

None of the clinical trials in the past assessed the exact occurrence of cardiac events in community living normal individuals while consuming coconut oil as their oil sources for food. Also the ethnic variation in the outcome while using coconut oil is yet to be studied To address the above issues a large, randomized population based study to assess the exact occurrences of cardiac events as well as to measure the intermediate outcome like lipid profile  is highly warranted.