Diet is important for the prevention of atherosclerotic cardiovascular disease as a component of therapeutic lifestyle interventions. In fact, the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for the management of dyslipidemia, emphasize the importance of nutritional approaches that can be used alone or in combination with pharmacological therapies to manage hypercholesterolemia to reduce cardiovascular disease risk. Current recommendations focus on improving diet quality by encouraging a Mediterranean-style diet that includes fruits, vegetables, legumes, nuts, whole grains and breads, and fish (especially oily fish); replacing saturated fats with unsaturated or monosaturated fats and eliminating trans fatty acids; replacing single carbohydrates with complex carbohydrates with a low glycemic index; and limiting the intake of sugar/fructose and alcohol. Recent findings from the PrediMed Research Center demonstrate that small changes in diet quality can contribute to a gradual reduction in the risk of cardiovascular disease events. There is also emerging evidence to consider the role of Œfunctional foods¹ as a component of the diet. The consumption of foods fortified with phytosterols/sterols or soluble (viscous) fiber (e.g., in oats) is associated with an appropriate reduction in low-density lipoprotein cholesterol (LDL-C) and, therefore, it can be used in the management of such patients in whom an overall cardiovascular risk assessment indicates that pharmacologic therapy is not appropriate. Indeed, the use of a combination diet (including phytosterols, viscous fiber, soy protein, and nuts) has been shown to have a progressive reduction in LDL-C in 20-30% of areas, and therefore may be one of the best dietary approaches to reduce cardiovascular disease risk. The key issues associated with the adoption of a heart-healthy diet are 1) long-term adherence and 2) low cost. It is imperative that research first addresses how to ensure that dietary changes are sustainable. In addition, in the current climate of austerity in Europe, cost may seriously affect the choice of a Mediterranean-style diet. Both of these thorny issues need to be addressed by engaging public health researchers and policy makers to ensure optimal outcomes of dietary interventions.