The primary objectives of current dietary advice for those at risk from coronary artery disease (CAD) focus on progressive restriction of dietary saturated (and trans) fatty acids and cholesterol intake, combined with exercise and achievement of ideal body weight. These principles are endorsed by the official bodies of most western nations concerned with reducing CAD mortality and have recently been reaffirmed by the Adult Treatment Panel of the National Cholesterol Education Program. There has been concern, however, in view of the increasing use of drug therapy, that additional strategies should supplement the primary goals to increase the palatability and effectiveness of the diet. These additional strategies include increased intake of foods high in soluble viscous fibres, vegetable proteins, possibly antioxidants such as vitamin E and the isoflavonoids, increased intake of alpha-linolenic acid and, for those with low high density lipoprotein cholesterol levels, increased monounsaturated fat intake. These strategies translate into advice to significantly increase consumption of specific plant foods such as green leafy vegetables, nuts and seeds, and dried legumes, all of which improve the overall nutritional quality of the diet and contain specific active ingredients. These changes represent a regression to a more primitive diet on the evolutionary scale.