The environment in which the field of cardiology finds itself has been rapidly changing. This supplement, an expansion of a report created for the Board of Trustees, is intended to provide a timely snapshot of the socio-economic, political, and scientific aspects of this environment as it applies to practice both in the United States and internationally. This publication should assist healthcare professionals looking for the most recent statistics on cardiovascular disease and the risk factors that contribute to it, drug and device trends affecting the industry, and how the practice of cardiology is changing in the United States.

Potential complications of intracoronary stenting include stent dislodgement and embolization. We describe a patient in whom a stent was dislodged from a coronary balloon catheter to the iliac artery. A peripheral angioplasty balloon was used to withdraw the stent into the arterial sheath and thereby remove it from the patient.

Hawkes WC, Laslett LJ. Selenium supplementation does not improve vascular responsiveness in healthy North American men.

It has been unclear whether exercise training of patients with coronary artery disease increases the level of myocardial oxygen consumption, as indicated by heart rate and double product of heart rate and systolic blood pressure, at which electrocardiographic evidence of myocardial ischemia develops. To assess this question we evaluated the experience of 10 patients with coronary artery disease who underwent a modest-level exercise training program for 6 months. All of these subjects had achieved a training effect, had developed electrocardiographic evidence of ischemia during initial exercise testing, had not increased the amount of cardiac medication taken, and had not been taking digoxin. After completion of the training period, the mean heart rate at which electrocardiographic evidence of ischemia developed increased from 107 + 19 to 119 + 23 beats/min (p < .05) and the mean double product increased from 166 + 18 to 209 + 51 x 102 mm Hg X beats/min (p < .05). Eight of the 10 patients demonstrated an increase in heart rate at onset of ischemia (p < .02), and seven of the eight in whom double product could be assessed manifested an increase in this parameter at onset of ischemia (p < .05). Thus the rate of myocardial oxygen consumption at which myocardial ischemia develops, as indirectly assessed by heart rate and double product, can be favorably altered by 6 months of moderate-level exercise training. Circulation 71, No. 5, 958-962, 1985. AEROBIC exercise training is an established modality of treatment for patients with a variety of manifestations of coronary artery disease.1 2 The well-documented benefits of training include increased maximal functional capacity and decreased heart rate response to submaximal workloads. Because heart rate is a major determinant of myocardial oxygen consumption,3 training of patients with coronary artery disease often allows them to perform at a greater activity level before the onset of ischemia. Unresolved is the important question of whether there is an actual increase in the "ischemic threshold" of heart rate or double product (of heart rate X systolic blood pressure) at which ischemia appears. Evidence bearing on this question has been conflicting and sparse.i9 To explore this issue further, we have evaluated the influence of exercise training on the onset of electrocardiographic evidence of exercise-induced myocardial ischemia in patients

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