ease remains the number one cause of death in the Western world. In 1996, 476,800 deaths were attributed to this disease. Including associated vascular pathology such as stroke and peripheral vascular disease, the annual health care cost of atherosclerotic heart disease is estimated at 51 billion dollars.1 The trend in medicine has been to recognize and treat atherosclerosis by identifying negative risk factors that directly correlate with the prevalence of coronary artery disease (CAD), such as low-density lipoprotein (LDL), hypertension, diabetes mellitus, and smoking. Although these risk factors identify most people with CAD, identification of these factors still does not answer all the questions that must be addressed from a preventive medicine standpoint. What is the physiologic effect of each negative risk factor that manifests as CAD? Why do some people with a significant risk of atherosclerosis not manifest CAD? Are there factors that can be identified to protect patients from manifesting CAD? How can physicians help those patients at risk for CAD to slow the disease progression and reverse the effects of CAD by maximizing protective factors? These questions are but a few of those left unanswered. The traditional approach to medical management of vascular diseases has only partially answered these questions. This article proposes that complete answers can be found by focusing on the pathophysiology of atherosclerosis and the influence that nutrition plays on this process. Over the past two decades a significant amount of research has been performed, revealing the full spectrum of factors that affect the complicated process of CAD. Based on this research, most of the medical community has focused on three forms of primary prevention: LDL cholesterol reduction, β-blocker therapy, and anti-platelet therapy. Although these interventions have prolonged lives, physicians have yet to significantly lower the incidence of mortality caused by ischemic heart disease during the past 10 years.1 Why is this the case? This article proposes that, in order for primary prevention of atherosclerosis to move to a new level, physicians must focus on the effects of nutrition. The purpose of this article is to review the latest research and identify harmful as well as protective nutritional factors that may aid in the prevention and treatment of CAD.