It is becoming clear that genetic and environmental factors can interact to varying degrees in a given individual. In some cases, genetically determined resistance to CAD (eg, genetic hyperalpha- or hypobetalipoproteinemia), or genetically determined susceptibility to CAD (eg, high Lp[a] levels) may not be significantly modulated by a prudent lifestyle. Estimates of the prevalence in the general population of these genetic extremes average around 5% (4). In the remaining 95% of cases, nature and nurture interact. For example, a genetic flaw that is usually expressed phenotypically as premature death due to CAD (eg, some cases of FH) can be ameliorated by a prudent diet. There is little doubt that an individual's responsiveness to environmental factors can be determined by many different genes. The exact candidate genes and the nature of most of the genetic changes affecting response to diet still need to be determined. Once identified, they may one day form the basis for early diagnosis of metabolic problems and individually tailored diet and drug treatment programs.