Current dietary recommendations to decrease coronary heart disease (CHD) risk in the general population include reduction of total fat intake to less than or equal to 30% of energy, saturated fat to less than 10% of energy, and dietary cholesterol to less than 300 mg/day. Further restrictions in saturated fat to less than 7% of energy and in dietary cholesterol to less than 200 mg/day are indicated for those individuals with elevated low-density lipoprotein (LDL) cholesterol concentrations. Under controlled conditions, such diets reduce LDL cholesterol by 15% to 20%. However, in the out-patient setting, only 5% to 10% reductions in LDL cholesterol have been achieved, and large variability in dietary response is observed due to differences in compliance, as well as to genetic heterogeneity. This article reviews epidemiologic studies and dietary intervention trials that support a direct relationship between diet, lipoproteins, and CHD risk, with the ultimate goal of providing a framework for dietary management of the hyperlipidemic patient.