Patients with SIHD should be educated about the following lifestyle elements that could influence prognosis: weight control, maintenance of a BMI of , and maintenance of a waist circumference less than 102 cm (40 inches) in men and less than 88 cm (35 inches) in women (less for certain racial groups)8,440,449 452; lipid manage- ment18; BP control17,453; smoking cessation and avoidance of exposure to secondhand smoke8,454,455; and individualized medical, nutrition, and lifestyle changes for patients with diabetes mellitus to sup- plement diabetes treatment goals and education.456 (Level of Evidence: C) Class IIa 1. It is reasonable to educate patients with SIHD about: a. adherence to a diet that is low in saturated fat, cholesterol, and trans fat; high in fresh fruits, whole grains, and vegetables; and re- duced in sodium intake, with cultural and ethnic preferences incorporated8,17,18,457,458 (Level of Evidence: B); b. common symptoms of stress and depression to minimize stress-related angina symptoms459 (Level of Evidence: C); c. comprehensive behavioral approaches for the management of stress and depression237,460 462 (Level of Evidence: C); and d. evaluation and treatment of major depressive disorder when indicated.237,238,437,461,463,464,467,468 (Level of Evidence: B) Multiple risk factors for heart disease, vascular disease, and stroke are typically present in persons with SIHD, including hypertension, smoking, dyslipidemia, diabetes mel- litus, overweight, and physical inactivity.27,392 At a national level, in 2000, only 5% of individuals without IHD and 7% of those with IHD were fully adherent to recommendations for physical activity, fruit and vegetable consumption, and nonsmoking. The approach to managing risk factors usually requires partnerships among the healthcare team, the patient, their family, and their community. 