Cardiovascular medicine James T. Willerson, Jay N. Cohn, New York, 1995, Churchill Livingstone, 1976 pages, $115. This is the first edition of a major new textbook on cardiovascular medicine. The book is edited by two outstanding cardiologists, James T. Willerson, MD, and Jay N. Cohn, MD, and it has an excellent list of contributing authors. The book is comprehensive, covering all major aspects of cardiovascular disease. Importantly, throughout the text, relevant pathophysiology is well integrated into the clinical presentation, and management of each of the major diseases is discussed. Where appropriate, surgical therapy is also well discussed, but primarily with a focus on the results of clinical trials comparing surgical with medical therapy. Selected chapters have a good, but not comprehensive, discussion of the surgical management of various diseases. These include, for example, coronary artery disease, congestive heart failure and heart transplantation, and peripheral vascular diseases. Given the intended scope of this text, it does not provide a comprehensive discussion of the surgical management of all cardiovascular diseases. For these discussions, the reader is directed to more appropriate surgical texts, which present a broader scope of the technical aspects of the treatment of cardiovascular disease. This textbook has several unique features that make it a desirable addition to the library of general surgeons, vascular surgeons, and physicians specializing in cardiovascular disease. For example, there is an excellent section on cardiac metabolism, presenting many important concepts underlying the current treatment of cardiovascular disease. Generally omitted in previous texts, these have now become the target of numerous therapeutic approaches. For example, the understanding of glucose and fatty acid metabolism in cardiac muscle has led to the development of new imaging techniques, as well as new treatment modalities designed to stimulate appropriate aspects of metabolism in the ischemic or the reperfused heart. This is only one example of how this text is addressing many important current issues in the management of cardiovascular disease. Another unique feature of this text is a very extensive chapter on the new discipline of vascular medicine. This section begins with an excellent discussion of many basic considerations in vascular biology. This discussion includes regulation of vascular tone in terms of vascular smooth muscle, as well as the role of the endothelium in regulating vasoconstriction and vasodilation. This section also discusses the role of several disease states such as hypertension and hyperlipidemia from the perspective of abnormal vascular responses. This leads to a discussion of vascular remodeling, an important characteristic of peripheral and coronary artery diseases. After this is an excellent discussion of the major vascular diseases, including diseases of the aorta, the peripheral circulation including carotid and peripheral arterial occlusive disease, as well as the role of intravascular ultrasonography in the diagnosis of these diseases. Although this section does not present a complete or comprehensive discussion of all peripheral vascular diseases, it does present a unique perspective on the role of vascular medicine in the management of peripheral arterial and venous diseases. For this reason, this chapter alone would make purchase of the book worthwhile for the vascular surgeon or vascular internist. Although there is a chapter on the evaluation of patients for non-cardiac surgery, it would have been nice to have seen a more extensive discussion on the unique aspects of the evaluation of patients for peripheral vascular surgery, given their high cardiac risk. In summary, this is an excellent addition to what are now several textbooks on cardiovascular disease. This textbook is of high quality and should successfully compete with the other major texts in this area. This text is highly recommended for both surgeons and internists interested in the treatment of patients with cardiovascular disease, including peripheral arterial disease.