A New Approach to Coronary Heart Disease

G EORGE Bernard Shaw has said, "The reasonable man adapts himself to the world; the unreasonable man persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man." Cardiologists must be "unreasonable men" if they are to find a way to slow the rapidly increasing incidence of coronary heart disease. We must find some approach that takes into consideration Americans' penchant for eating too much, smoking too much, and exercising too little, often in a stressful environment. That we probably cannot change. But if we could identify high risk patients early and persuade them to make major alterations in their life style, we could substantially reduce the likelihood that they will suffer a myocardial infarction. Diagnostic tests for the detection of coronary heart disease are designed for four distinct groups: 1) the general adult population during periodic health examinations; 2) patients with symptoms suggesting coronary artery disease such as chest pain; 3) patients with objective evidence of coronary artery disease such as abnormal electrocardiograms; and 4) patients being considered for coronary artery surgery. The 6,016 cardiologists in the US1 who restrict their practice to the care of patients with heart disease are not enough to serve