Strategies in Primary and Secondary Prevention of Coronary Artery Disease [antikvár]

PrefaceWhile preventive strategies in cardiovascular medicine have not made significant headway over the past 20 years, new -mostly technical - therapeutic methods, such as coronary bypass surgery, balloon angioplasty and thrombolysis, have shown more dramatic progress. In hospital mortality of acute myocardial infarction is now below 10%, largely due to the use of systemic fibrinolytic therapy. On the other hand, overall mortality from myocardial infarction is still remaining close to 60% (MONICA-project) due to death in the very early phase of the ischemic event outside the hospital. Mortality of a second infarction is even higher. Clearly, the number one cause of death has not yet been defeated and in-hospital mortality of myocardial infarction is unlikely to see further substantial reductions. In light of these data, a greater emphasis on preventive strategies - both primary and secondary - may now be a more rational approach to this continued challenge. Measures of primary prevention are not spectacular, only little attractive and will interfere with accustomed lifestyles. Yet, there is a chance that new qualities of life may be discovered, with respect to more healthful eating patterns, a physically more active life and better stress coping capabilities.For so called "secondary" prevention a number of - mostly medical - strategies are available for individualized therapy, targeting against sudden cardiac death.progressive left ventricular dilatation, reinfarction, accelerated CAD and coronary artery reocclusion in patients with manifest CAD, after myocardial infarction and after coronary interventions. In particular the latter group of patients is growing steadily and has stimulated a new "subspecialty" in secondary prevention, namely prevention of recurrent stenosis. Current data, however, suggest, that the disease process of the primary and secondary lesion may not be all that different. It was our goal to gather those researchers in cardiology, which are oriented towards (old and new) issues of the broadening spectrum of "preventive cardiology" in order to approach the unsolved problems more concertedly and to create a comprehensive and updated view of this field.We are indebted to the contributing authors, who showed great enthusiasm for this project and who have supplied their manuscripts in time.It was a pleasure to cooperate with the Zuckschwerdt Publishing Company, which handled the project very expeditiously and with great care. In particular we thank Mrs. Jeannette Ischinger, who "handled" the Symposium (Recent Advances in Primary and Secondary Prevention of Coronary Artery Disease, Munich, June 20-22, 1991], the authors and the manuscripts with equal care and success and never stated, that this was really to be the last book project in her life Thomas Ischinger MunichMarch 1992Helmut Cohike Bad KrozingenV