These controversial diets include the Dean Ornish program and the Atkins diet.
The Dean Ornish program advises a low-fat, vegetarian approach coupled with exercise, stress reduction, and smoking cessation. This diet appears to reduce the risk of CAD, but again the reduction is modest and only formally tested by coronary angiograms in a few individuals. There is no randomized trial or large trial that has tested this diet. In addition, cessation of smoking is vitally important, but stress reduction and exercise are additive. Thus, the effect of the Ornish dietary program has not proven its value and is particularly difficult to follow for the long period of time necessary to significantly alter the risk for coronary events.
The Atkins- type diet was tested in a small study con¬ducted in only 45 adults. The 45 adults were rando¬mized and assigned to eat a high-fat, low-carbohydrate diet or a low calorie, high-carbohydrate, low fat [incorrectly called ‘‘conventional diet’’]. After a short period of only three months, the dangerous plasma LDL cholesterol increased in the low-carbohydrate, high-fat group and decreased slightly in the low-fat group. Thus the Atkins-type diet may substantially increase the risk for atheroma development and progression in individuals who have a propensity to develop cardiovascular disease (see the chapters Obesity and Heart Disease and Atherosclerosis/ Atherothrombosis).

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