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A Lesson in Expectations

Oglesby Paul, MD; Charles H. Hennekens, MD

JAMA. 1991;266(9):1267-1268.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Not surprisingly, the investigator in the biological sciences relishes the setting in which nature has provided a discrete, well-defined disease in which a single causative factor has been identified and for which a preventive or curative agent has become available. Coronary heart disease is not such an entity, which thereby complicates the design, execution, and interpretation of human clinical studies.

The pathological and physiological aspects of coronary disease reflect this complexity. Although the atheroma in the arterial wall has been identified for over 100 years as the chief lesion, it is known that an altered coagulation state plays a variable primary or secondary role, with the interplay of thrombosis on the one hand and thrombolysis on the other. Further, the existence of primary and/or secondary coronary arterial spasm has become recognized as a significant element. Although none of these can be regarded as totally separate and . . . [Full Text PDF of this Article]

Author Affiliations
From the Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.

Footnotes
Reprint requests to Countway Library of Medicine, Harvard Medical School, 10 Shattuck St, Boston, MA 02115 (Dr Paul).

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