Cardiovascular disease remains the most significant cause of morbidity and mortality in the United States. In 1990, 1.5 million Americans experienced a myocardial infarction; approximately 500,000 of them died.1 It is estimated that 6.1 million Americans are alive today with a history of myocardial infarction, angina, or both. The financial impact of this disease is enormous. The cost estimate for cardiovascular disease in 1992 was $108.9 billion. It is important for all primary care providers to implement screening and preventive care programs to reduce the burden of cardiovascular disease for the population in general and for the individual patient. Because of the high morbidity and mortality, it is also important to recognize the early manifestations of this disease.