Abstract
Heart failure is one of the major causes of death throughout the world. For over 65 years, it has been thought that cholesterol in the plasma was responsible for heart failure. I have never believed that cholesterol causes heart failure. This perspective presents evidence that it is oxidized cholesterol and trans fat in the diet that are the causes. It is these two lipids in the diet, rather than cholesterol in the plasma, that are responsible for heart failure. The oxysterols change the structure of the coronary arteries so that they are more susceptible to calcification and increase the synthesis of thromboxane. The trans fatty acids inhibit prostacyclin synthesis that cause the blood to clot. I believe that removing these two lipids from the diet would prolong the lives of hundreds of thousands of people annually.