The major cardiovascular diseases affecting Japan and other developed countries have atherosclerosis at their core. Progression of atherosclerosis is remarkably affected by diet and can be approached by dietitians or nutritionists. Pathogenesis of atherosclerosis is multifactorial. And the risk factors include hypercholesterolemia, glucose intolerance/diabetes mellitus, hypertension, and metabolic syndrome. Postprandial hyperlipemia and hyperglycemia may also be new targets because most of a day is spent in a postprandial state in these countries and the recent evidence suggests that these conditions in fact promote atherosclerotic processes. The preventive measures including dietary approaches must be started as early as possible in life because the bud of atherosclerosis may begin in fetuses. Improving diet and lifestyle should be the central strategy for the prevention of atherosclerotic diseases.