Role of the cardiologist in peripheral vascular disease.

We are witnessing an increasing interest in peripheral vascular disease among cardiologists. A field that had previously been left to the surgeons and radiologists in many practice environments is now attracting participation by cardiologists. Anthony D eMaria . MD commented on this trend 3 years ago in a Presidents Page (!) and defined the response of the American College of Cardiology . In this President `s Page, 1 will expand on his excellent summary of the issues involved and the continuing efforts of the ACC to provide leadership in this area . Changing perspective on the vascular component of heart disease . Why is vascular disease now attracting so much attention? My colleague . Jack Spinell, MD, has identified the primary stimulus for [his trend as the lure of performing angioplasty in the peripheral vascular system 12) . No doubt this is a major stimulus . however. i n my judgment . the change in the types of disease that dominate the practice of cardiologists also explains why peripheral vascular disease is now of more importance to cardiologists. In my earliest days of clinical cardiology practice, in the early 19GOs the patients were primarily those with congenital and yalvular heart disease . There was little invcstigatioa in patients with coronary artery disease because therapy was limited at that time . Moreover, patients with acute myocardial infarction were treated in an extremely conservative manner and, by today's. standards. incorrectly. Although there was a high prevalence of coronary heart disease, its vascular component was not emphasized in the work of most cardiologists . This was reflected in my own institution, the Mayo Clinic . where sepamrn sections for cardiology and peripheral vascular disease had been established . Today . however, with the advances in early detection and treatment of congenital heart disease, the near eradication of rheumatic valvular disease . the introduction of coronary