Cardiovascular disease has a multifactorial aetiology, as is illustrated by the 
existence of numerous risk indicators, many of which can be influenced by 
dietary means. It should be recalled, however, that only after a 
cause-and-effect relationship has been established between the disease and a 
given risk indicator (called a risk factor in that case), can modifying this 
factor be expected to affect disease morbidity and mortality. In this paper, 
effects of diet on cardiovascular risk are reviewed, with special emphasis on 
modification of the plasma lipoprotein profile and of hypertension. In addition, 
dietary influences on arterial thrombotic processes, immunological interactions, 
insulin resistance and hyperhomocysteinaemia are discussed. Dietary lipids are 
able to affect lipoprotein metabolism in a significant way, thereby modifying 
the risk of cardiovascular disease. However, more research is required 
concerning the possible interactions between the various dietary fatty acids, 
and between fatty acids and dietary cholesterol. In addition, more studies are 
needed with respect to the possible importance of the postprandial state. 
Although in the aetiology of hypertension the genetic component is definitely 
stronger than environmental factors, some benefit in terms of the development 
and coronary complications of atherosclerosis in hypertensive patients can be 
expected from fatty acids such as alpha-linolenic acid, eicosapentaenoic acid 
and docosahexaenoic acid. This particularly holds for those subjects where the 
hypertensive mechanism involves the formation of thromboxane A2 and/or alpha 
1-adrenergic activities. However, large-scale trials are required to test this 
contention. Certain aspects of blood platelet function, blood coagulability, and 
fibrinolytic activity are associated with cardiovascular risk, but causality has 
been insufficiently proven. Nonetheless, well-designed intervention studies 
should be initiated to further evaluate such promising dietary components as the 
various n-3 and n-6 fatty acids and their combination, antioxidants, fibre, etc. 
for their effect on processes participating in arterial thrombus formation. 
Long-chain polyenes of the n-3 family and antioxidants can modify the activity 
of immunocompetent cells, but we are at an early stage of examining the role of 
immune function on the development of atherosclerotic plaques. Actually, there 
is little, if any, evidence that dietary modulation of immune system responses 
of cells participating in atherogenesis exerts beneficial effects. Although it 
seems feasible to modulate insulin sensitivity and subsequent cardiovascular 
risk factors by decreasing the total amount of dietary fat and increasing the 
proportion of polyunsaturated fatty acids, additional studies on the efficacy of 
specific fatty acids, dietary fibre, and low-energy diets, as well as on the 
mechanisms involved are required to understand the real function of these 
dietary components. Finally, dietary supplements containing folate and vitamins 
B6 and/or B12 should be tested for their potential to reduce cardiovascular risk 
by lowering the plasma level of homocysteine.