I. Diets
II. Trans Fatty Acids and Coronary Artery Disease
III. Diet–Drug Valvulopathy
IV. Fish Oils

GLOSSARY
angina chest pain caused by temporary lack of blood to an area of heart muscle cells, usually caused by severe obstruction of the artery supplying blood to the segment of cells.
coronary artery disease obstruction of the coronary arteries with symptoms such as chest pain, angina, or heart attacks.
myocardial infarction death of an area of heart muscle due to blockage of a coronary artery by blood clot and atheroma; medical term for a heart attack or coronary thrombosis.
CORONARY ARTERY DISEASE (CAD) IS A CAUSE OF serious cardiac events including angina and myocardial infarction which may be fatal or nonfatal. Diets to prevent CAD have been advocated for more than 40 years. Several weight-reduction diets have been fashionable over the past 50 years. The prevalence of obesity (body mass index or BMI > 30) and the population of overweight individuals (BMI > 25) has increased dramatically in North America during the last 20 years(^43% of the United States in 1961 vs. ^55% in 1994). This increase has occurred despite attempts at dietary controls. In this population of patients the risk for diabetes and CAD is increased. Waist circumference of greater than 35 inches in women and greater than 40 inches in men is an easily measured marker of increased CAD risk.

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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.