The main health hazard of atherosclerosis is coronary heart disease (CHD). Its relation to nutrition (chiefly saturated fat) was shown through the Seven Countries Study and confirmed by between country comparisons. Nevertheless, cholesterol, the accepted intermediate link in blood, can no longer be used to explain differences between countries. In addition, when previous trials to decrease CHD by diet were efficient, rapid protection was observed (within a year), an effect not attributed to atherosclerosis but to thrombosis, which is responsible for myocardial infarction. Thrombogenesis is directly increased by saturated fat, but decreased only by n-3 fatty acids and alcohol through decreasing platelet reactivity. A Mediterranean diet with more cereals, vegetables, fruit, less saturated fats and more n-3 fatty acids has recently been shown to afford a rapid and exceptional protection from recurrences and death in coronary patients. The relationship between nutrition and CHD is thus as close as suggested, but more complex, because of additional nutrients, such as alcohol and natural antioxidants, and an appropriate balance between fatty acids.