Primary and secondary prevention of ischemic heart disease.

Coronary heart disease remains the most common cause of death among men and women in the United States. With an estimated cost of $56 billion annually for the treatment of heart disease, and an increasing prevalence due to aging of the population, both primary and secondary prevention of coronary heart disease take on major public health importance. New insights into the relationship between smoking, hypertension, physical activity, dyslipidemia, obesity, hyperinsulinemia and diabetes mellitus, clotting factors, and alcohol and the subsequent development of coronary heart disease are reviewed and means of intervention are highlighted. The role of aspirin, beta-blockers, calcium-channel blockers, antiarrhythmics, and angiotensin-converting enzyme inhibitors in the secondary prevention of myocardial infarction are briefly reviewed and the potential role of hormone replacement therapy in women is discussed.