The world's advanced countries have easy access to plentiful high-fat food; ironically, it is this rich diet that produces atherosclerosis. In the world's poorer nations, many people subsist on a primarily plantbased diet, which is far healthier, especially in terms of heart disease. To treat coronary heart disease, a century of scientific investigation has produced a device-driven, risk factor-oriented strategy. Nevertheless, many patients treated with this approach experience progressive disability and death. This strategy is a rear-guard defensive one. In contrast, compelling data from nutritional studies, population surveys, and interventional studies support the effectiveness of a plant-based diet and aggressive lipid lowering to arrest, prevent, and selectively reverse heart disease. In essence, this is an offensive strategy. The single biggest step toward adopting this strategy would be to have Unit- I have drawn two compelling observations from my service as the program director of two national cholesterol conferences and my participation in three others over the past decade. First, a great deal is known about what factors are responsible for causing coronary artery disease (CAD) and what populations are vulnerable. Second, the present emphasis on identifying risk factors and those who are particularly vulnerable to atherosclerotic disease will not resolve the cardiovascular epidemic, which currently threatens one of every two Americans and is predicted to become the number one global disease burden by the year 2020. 1Autopsy data from the conflicts in Korea 2 and Vietnam, 3 the Bogalusa study, 4 and the Pathological Determinants of Atherosclerosis in Youth (PDAY) 5 study all testify to the ubiquitous nature of the disease in young Americans. Recently, intra-arterial ultrasonography confirmed that "normal" segments in patients with CAD also have diffuse symmetric atherosclerosis, which is not yet disfiguring the intraluminal diameter and thus is invisible on angiography. 6 This work is further confirmation of the Roberts autopsy data, 7 which demonstrate that essentially all patients with ischemic heart disease have triple-vessel involvement.However, CAD is virtually absent in cultures that eat plant-based diets, such as the Tarahumara Indians of northern Mexico, 8 the Papua highlanders of New Guinea, 9 and the inhabitants of rural China 10 and central Africa. 11 Hundreds of thousands of rural Chinese live for years without a single documented myocardial infarction. 12 Modern North Americans and Europeans pride themselves on having the world's most advanced medical care. What are these health care systems doing about CAD?
PRESENT HEART DISEASE MANAGEMENT STRATEGIESThe present strategy focuses on interventional procedures and risk factor modification. This approach is strictly defensive. It is pressing the limit of what society can afford. Our present cardiology budget exceeds one quarter trillion dollars per year. 1 Millions of symptomatic patients-generally, those with arterial stenosis of more than 70...