Cardiovascular therapies in the 1990s. An overview

Cardiovascular medicine has evolved steadily over the past two decades. Inspired by progressive declines in the overall incidence and mortality rates from cardiovascular diseases, emphasis has been placed on 3 specific areas: prevention, early diagnosis, and aggressive intervention. During the decade spanning the 1980s, impressive strides were made in many areas--diagnostic and therapeutic alike. However, an observed reduction in patient mortality stemming from acute myocardial infarction was particularly gratifying. Clearly, the large scale use of thrombolytic therapy and postinfarction strategies designed to prevent reinfarction, limit ventricular dilation, and reduce cardiac death figured prominently. Despite these encouraging facts, however, coronary heart disease remains the leading cause of death in Western society, and thrombolytic therapy is still not being utilised by the medical community to its full potential. Furthermore, adjuvant therapy, during both the early and the late phases of acute myocardial infarction, is being instituted inconsistently, and at times haphazardly. Arrhythmia management and the prevention of sudden cardiac death require further investigation, as does the treatment of chronic congestive heart failure, and the prevention of coronary atherosclerosis. This overview provides a state-of-the-art review and look into the future of 5 critical areas: acute myocardial infarction, adjuvant treatment strategies for acute myocardial infarction, cardiac arrhythmias, chronic congestive heart failure, and hyperlipidaemias.