Cardiovascular disease (CVD) accounts for almost 50% of all deaths in 
industrialized nations. As much as 70% of CVD can be prevented or delayed with 
dietary choices and lifestyle modifications. Western-style diets, sedentary 
lifestyles, and cigarette smoking are key modifiable CVD risk factors. Although 
CVD mortality was trending downward for almost 50 years, a resurgence, both 
nationally and globally, has occurred. A growing epidemic of obesity 
("globesity"), decreasing physical activity, and persistent cigarette smoking 
are major behavioral factors underlying this change. Diet and lifestyle increase 
CVD risk both directly and indirectly. Direct effects include biological, 
molecular, and physiologic alterations, including inflammatory stimuli and 
oxidative stresses. Indirect effects include diabetes, dyslipidemias, and 
hypertension. However, trials studying links between diet and CVD remain 
notoriously difficult to execute and interpret. Diet interventions are typically 
confounded by other aspects of an overall diet as well as by lifestyle. 
Furthermore, benefits derived from a specific dietary or lifestyle intervention 
may not be proportional to the degree of risk posed by the unhealthy diet or 
lifestyle. Nonetheless, therapeutic rationale for diet and lifestyle are 
supported by basic and clinical research. Key components of a healthy aggregate 
diet include 1) reduced caloric intake; 2) reduced total fat, saturated fat, 
trans fat, and cholesterol with proportional increases in monosaturated, n-3 
(omega-3), and n-6 fatty acids; 3) increased dietary fiber, fruit, and 
vegetables; 4) increased micronutrients (eg, folate, B6, B12); 5) increased 
plant protein in lieu of animal protein; 6) reduced portions of highly processed 
foods; and 7) adopting a more Mediterranean or "prudent" dietary pattern over 
the prevailing "western" dietary pattern. Key lifestyle interventions include 
increased physical activity and smoking cessation. Translation of the benefits 
of healthy diet and lifestyle to the wider population requires both individual 
and public health strategies targeting at-risk groups.