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The purpose of this study was to follow the progress of 64 patients with documented coronary artery disease who had been recommended for bypass surgery and who attended a 26-day residential program at the Pritikin Longevity Center where they were exposed to a high-complex-carbohydrate, low-fat, low-cholesterol diet and to intensive exercise and educational programs. Serum cholesterol was reduced from 222 ± 6 to 167 ± 4 mg/dl at the Center and was 202 ± 6 mg/dl at follow-up. Respective triglyceride values were 179 ± 16, 126 ± 7, and 140 ± 15 mg/dl. At follow-up, 85% of the patients claimed a 50% or greater adherence to the diet; 77% indicated that they still followed a regular exercise program. During the five years of follow-up in this high-risk group, there was one death from cancer and three from cardiovascular complications (one during surgery for mitral valve replacement). Two patients experienced recurrent infarctions, and two experienced new infarctions. Twelve patients underwent coronary artery bypass graft surgery. Eighty percent had angina at entry into the program, and only 32% indicated that they had definite angina at follow-up. In addition, cardiac and hypertensive medications were discontinued in many patients. These data indicate that a very low-fat and low-cholesterol diet in combination with exercise may be an effective adjunct for treating patients with coronary artery disease, along with regular medical management or following bypass graft surgery.