Diet and Coronary Artery Disease

ATHEROSCLEROSIS of the coronary artery is currently the leading cause of death in the United States and in many western 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. Although 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 The concept of any disease arising from a single cause is obsolete and misleading.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 clarify our concepts of that disease. " 2 Atherosclerosis is undoubtedly a disease of multiple causation, which appears to have so many determinants 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 complex interaction between host and environment. Instead of arising in the environment and constituting an independent variable such as the agents of infection, allergy, poisoning, 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 usual