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The prevalence of coronary artery disease shows no signs that it is declining, yet mortality is decreasing and advanced methods of treatment are creating a large population of individuals with a substantially damaged left ventricle. Clinical observations and experimental data provide convincing evidence that postischemic damage is progressive even in the absence of a fresh is-chemic insult. Any intervention capable of preventing or limiting this progression can reasonably be expected to make a strong favorable impact on the prevalence and severity of heart failure, defined as symptomatic ventricular dysfunction. Preliminary data indicating that this desirable result can be achieved by the administration of ACE-inhibiting drugs to patients soon after the onset of acute Q-wave myocardial infarction are encouraging, but recommendations for a major change in current clinical practice will have to await the results of major multicenter trials now in progress.