Diet and Coronary Artery Disease

ATHEROSCLEROSIS of the coronary ar-tery is currently the leading cause of death in the United States and in many west-ern countries. It is remarkable that a disease that was not recognized clinically before 19121 could have in half a century come from this relative obscurity to the commonest cause of death in middle-aged and elderly persons. Al-though its exact etiology is far from settled, intensive study over the past three decades has pointed increasingly to nutritional factors as playing a prominent role. The concept of any disease arising from a single cause is obsolete and misleading. On the contrary, as Gordon pointed out, "To recognize a disease as the resultant of ecologic forces within the dynamic system made up of agent, host, and environment may often clar-ify our concepts of that disease. " 2 Athero-sclerosis is undoubtedly a disease of multiple causation, which appears to have so many de-terminants that they tend to defy orderly classification under titles of agent, host, and environment. It is certain that atheroma arises within the host as the result of a com-plex interaction between host and environ-ment. Instead of arising in the environment and constituting an independent variable such as the agents of infection, allergy, poison-ing, addiction, or vitamin deficiency disease, the agent of atherosclerosis is an endogenous and dependent variable. Since this agent arises within the host, it obscures the usua