Risk factor modification extends the benefit of coronary artery revascularisation procedures

The management of coronary artery disease has undergone major changes in the past three decades. Early medical preventive strategies rapidly gave way to surgical intervention by the end of the 1960s; 10 years later this was supplemented by the introduction of angioplasty. Both of these approaches offered rapid symptomatic relief but were dogged by a predisposition to restenosis. While technical improvements have helped reduce this problem, there is a growing perception that the imbalance between the enthusiastic adoption of surgical intervention and the jaundiced neglect of secondary medical prevention needs to be redressed. This can be achieved without stepping back in time, for, since the 1960s, agents far more effective in the struggle against ischaemic vascular disease have proven their worth in the clinical arena. Graft protection following bypass surgery is vital, but equally important is the need to target the metabolic derangement which caused the occlusion in the first place. This article reviews medical strategies designed to add life to coronary artery revascularisation procedures.