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Heart 411 is a very comprehensive and well written book, but the authors are very wrong on the optimal diet for heart disease. My qualifications for writing this review are four college degrees, research in many fields, extensive study of experimental design, and a history of three heart attacks, two angioplasties (before stents), and a triple bypass 22 years ago. At that time, I went on the Pritikin/Ornish/Esselstyn diet and have had no problems since. I run 5k races with full exertion and no chest pain. The authors recommend the Mediterranean Diet and statins. They say: "If you follow our advice, our waiting rooms will empty out, and you just might put us out of business." (p.531). Let's examine the truth of their assertions. In the Lyon Diet Heart Study (1999), the Mediterranean Diet was compared to the standard American diet. The subjects were patients who had one heart attack. The Mediterranean Diet did better than the standard American diet, but here is the bad news. Nearly one quarter (24%) of those on the Mediterranean Diet had another heart attack or died. Is a 1 in 4 chance of dying or having a second heart attack satisfactory for you? Those are bad odds in my opinion. The Pritikin/Ornish/Esselstyn diet has a success rate of nearly 100% in preventing future cardiac events. Although the Mediterranean diet may slow disease progression, you can actually stop your heart disease on the Pritikin/Ornish/Esselstyn diet. Do statins reliably stop heart disease? On page 53, the authors celebrate the, Scandinavian Simvastatin Survival Study, the 4S Study (1994), calling the study "proof" of the effectiveness of the statin and the results "stunning". They cite the dramatic reduction in the relative risk of those taking the statin. However, let's take a closer look. In the 4S study, there were 4,444 subjects, divided into two nearly equal groups. The subjects had either a heart attack or angina pectoris. Over 5.4 years, a major coronary event occurred in 622 (28%) of the control group and 431 (19%) of the statin group. This 9% absolute reduction of risk translates into a relative risk reduction of 30%. The overlooked finding is that 431 of the 2221 subjects treated with the statin (19.4%), had another major cardiac event, so your odds of avoiding a major cardiac event are 80.6% if you maintain your statin treatment (72% if you do not take the statin). This improvement in risk justifies treatment, but the numbers do not provide much reassurance. You have reduced the absolute risk by 9%. Compare this with the nearly 100% effectiveness of a totally plant based, whole food, no oil diet. In another recent statin study, called the SATURN study (2011), of which Dr. Nissen was an author, statins also failed to provide protection to 18% of the participants, despite the subjects taking "Maximal doses" of Crestor and Lipitor. There was a total of 1,380 subjects, and 244 (18%) continued to have negative cardiac events in two years. To illustrate this probability, think of a number between 1-6, then role a die. If your number comes up, you just had a major cardiac event despite a high statin dose. Although the study reports these doses were well tolerated, bear in mind that the FDA warned in February, 2012, of additional side effects of "memory loss, forgetfulness, and mental confusion" from taking statins. The Pritikin/Ornish/Esselstyn diet will raise your odds of avoiding all cardiac events from 82% to nearly 100%, without the risk of these side effects. Now let's turn to the positive alternative. Dr. Esselstyn reported in the American Journal of Cardiology (1999) his study of 18 patients who had 49 negative cardiac events prior to commencement of his plant based nutrition program. At the end of 12 years there had been one death from an arrhythmia. (An angiogram of this patient had revealed, however, that narrowings of the coronary arteries had improved.) There were no cardiac events in the other subjects during the 12 year period. My point is that the Mediterranean Diet and statin treatment are not reliable treatments to stop coronary artery disease. Their benefits are overblown and bring about complacency in patients. To be serious about stopping, rather than slowing, coronary artery disease you should examine the research and clinical results of Pritikin, Ornish, and Esselstyn (as well as Drs. John McDougall and Neal Barnard). Further evidence of the efficacy of the Pritikin and Ornish programs is that Medicare Part B, will pay most of the cost if you have had a heart procedure or angina. It is indeed a conundrum that Dr. Nissen and Dr. Esselstyn, both highly respected physicians can coexist in the same medical institution, the Cleveland Clinic, world renowned for treatment of heart disease. It is a testament to the openness and freedom within the Cleveland Clinic that both can express their opinions and practice medicine there. I do believe, however, that the authors of this book have failed their readership by not presenting a dietary program that will reliably stop coronary artery disease.