In patients where dyslipidemia is present, as defined by an elevated total cholesterol and low-density lipoprotein (bad) cholesterol, dietary restriction to reduce these elevated levels has shown a definite but modest reduction in risk for CAD; see the chapters Dyslipidemia and Cholesterol.

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• I. DIETS A. Controversial Diets
  These controversial diets include the Dean Ornish program and the Atkins diet.
• II. TRANS FATTY ACIDS AND CORONARY ARTERY DISEASE
  There is no doubt that trans fatty acids contribute signi¬ficantly to the risk of CAD. On a per gram basis, the effect on coronary risk of trans fatty acids is stronger than that of the well-known effects of saturated fatty acids.
• III. DIET–DRUG VALVULOPATHY A. Anorectic Agents
  Obesity is a risk factor for CAD, diabetes, and hyperten¬sion. Weight-reduction diets assist less than 25% of obese individuals; a return of weight gain is common, often within months of ending the diet that is difficult to adhere to for several years. For the past 50 years drugs have been sought to decrease appetite and food intake that results in significant weight loss. Most anorectic agents disappear from the market after 1–5 years because of adverse effects and adverse publicity. The drug phentermine (phen-fen) was approved in United States in 1959. This noradre-nergic agent was soon lost. Fenfluramine, a sympathomi-metic amine that activates the serotonergic pathways in the brain to induce its anorectic effects, and fenfluramine, the D-isomer of fenfluramine, were approved in 1973 and 1996, respectively. The combination of fenfluramine and phentermine appeared more efficacious than monotherapy, and it was widely prescribed from 1995 to 1998 to about 4.6 million individuals in the United States.
• IV. FISH OILS
  The low mortality from coronary heart disease in Green¬land Inuit is attributed to their intake of more than 350 g per day of whale and seal meat. In Japan, the incidence of coronary heart disease is much lower in areas where fish consumption is high, but the alpha-linolenic acid in soybeans and other products may be responsible for their low mortality from heart disease.
• BIBLIOGRAPHY
  Appeldoorn, C. C. M., Bonnefoy, A., Lutters, B. C. H., Daenens, K., van Berkel, T. J. C., Hoylaerts, M. F., Biessen, E. A. L. et al. Gallic acid antagonizes P-selectin – mediated platelet – leukocyte interactions: Implications for the French paradox. Circulation, 111:106–112, 2005.