There are several different approaches to providing perioperative cardioprotection. Although many of these strategies remain experimental or anecdotal, others have been studied in controlled trials.20 The former category includes synthetic oxygen carriers, antiplatelet agents, bradykinin antagonists, adenosine, opioid receptor agonists, and inflammatory mediator antagonists. Traditional perioperative pharmacotherapy has often included calcium channel blockers, nitrates, and α2-adrenoceptor agonists. As with β-adrenergic blocking agents, these agents affect the vasculature and myocardial oxygen consumption at several levels. For example, use of nitroglycerin decreases demand by its venodilatory properties. In addition, nitroglycerin is also a coronary vasodilator and direct nitric oxide donor. Although use of nitroglycerin intuitively makes sense and is supported in several studies, results of a conflicting study21 suggest that nitroglycerin use has no effect on intraoperative ischemia and might even be deleterious. While we support the use of adrenergic antagonists, it would be naive to suggest that use of these agents, alone, will independently confer protection. β-Adrenergic blockade should be part of a comprehensive pharmacologic strategy that includes other drugs, such as aspirin, angiotensin-converting enzyme inhibitors, and hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins), that reduce the risk of cardiovascular events.