The presumed mechanism by which these interventions work is stabilization of the coronary plaque to prevent rupture and thrombosis.8 These include antiplatelet agents,393 st- atins,394 401 and beta blockers, along with other agents if indicated, to control hypertension.402,403 ACE inhibitors are indicated in many patients with SIHD, especially those with diabetes mellitus or LV dysfunction.296,301,404 Simi- larly, tight glycemic control not only has not been shown to reduce the risk of macrovascular complications in patients with type 2 diabetes mellitus, it also appears to increase the risk of cardiovascular death and complications. Nonetheless, weight loss, aerobic exercise, an AHA Step II diet, and ACE inhibitors in patients with diabetes mellitus with proteinuria all can improve patients risks of microvascular complications and, potentially, cardiac events. For the purposes of this guideline, the writing committee elected to retain the classification for risk of cardiovascular events that has been accepted by consensus over the past 2 decades. Patients with a predicted annual cardiac mortality rate of ,1% per year are considered to be at low risk, those with a predicted rate of 1% to 3% per year are considered to be at intermediate risk, and those with a predicted average .3% per year are considered to be at high risk. For patients at high risk of mortality, the prevalence of severe CAD (eg, left main coronary occlusion) is higher, and coronary angiography can define the coronary anatomy and help to plan further therapy beyond standard GDMT (Figure 5). If the patient is at low or intermediate risk for mortality, therapeutic decisions should be directed toward improving symptoms and function, and catheterization may be deferred if symptoms can be controlled with medical therapy alone. 