The past 20 years have witnessed dramatic changes in our understanding and treatment of ischemic heart disease. In terms of management, two major trends, defining two categories of cardiologists, have emerged. The first is the fast-growing predilection for the invasive approach to coronary artery disease, epitomized by surgical or interventional reperfusion, both in the acute setting (primary angioplasty) and in the stable phase. Those who embrace this strategy are known as interventional cardiologists, and are engaged in what in effect is a sophisticated form of "plumbing." They are unrepentant technophiles, always on the lookout for the most up-to-date type of stent and the latest devices bristling with electronics. In stark contrast to this first category is the preventive cardiology approach. This is based on the rationale that intervention only takes care of a discrete manifestation of the disease, but fails to address the possibility that atherosclerosis may progress to another vessel or wreak havoc again in the same vessel that has been subjected to angioplasty or bypass surgery. It has been said that the preventive cardiologists would dearly love to ban their plumber colleagues from plying their trade...