"This study had several limitations. First, it included self-selected, very deter- mined patients. Without a control group, it is challenging to establish causa

"This study had several limitations. First, it included self-selected, very deter- mined patients. Without a control group, it is challenging to establish causality and as- sess how much of the observed changes are specifically due to the diet. Only some of the observed beneficial outcomes may have been due to the diet. This study was not pro- spectively randomized. Nevertheless, this fact does not detract from proof of concept that major cardiovascular events occurred in probably <1% (and certainly <10%) of the entire adherent cohort, compared with 62% of the nonadherent cohort (TaBlE 2). These data convey a strong message of patients accepting empowerment to be the locus of control to arrest their disease and confirm that patients will adopt a significant lifestyle transition to plant-based nutrition to halt and regress what we believe is a largely food- borne illness. The past several decades have witnessed a substantial and sustained reduction in CAD. Nevertheless, CAD remains the number one killer of women and men in this country. Thousands of stable patients having stents experience no reduction in major cardiac events.6 While drugs have some effects on disease initiation and progression, these in- terventions do not address disease causation. Not surprisingly, most patients experience disease progression, more drugs, more im- aging, repeat interventions, progressive dis- ability, and, too often, death from a disease of western malnutrition, the cause of which has been largely left untreated. We have in press several patient experiences that exemplify the repeated failure of present-day cardiac drugs and procedural interventions, and that confirm the capacity of whole-food plant- based nutrition to restore health in “there is nothing further we can do” situations.36 In summary, the present cardiovascular medicine approach tested beyond 40 years can neither cure the disease nor end the epi- demic and is financially unsustainable. The safety, diminished expense, and prompt, powerful, and persistent results in treating the cause of vascular disease by whole-food plant-based nutrition offer a paradigm shift from existing practice. We think the time is right for a controlled trial. But in the mean- time, the data are sound and strong enough that patients should be informed of this option."