Of this change, 47% can be attributed to treatments, including risk factor reduction after AMI, other guideline- based treatments for UA and heart failure, and revasculariza- tion for chronic angina.391 An additional 44% reduction in age-adjusted death is attributed to population-based changes in risk factors.391 Unfortunately, these changes have been offset somewhat by increases in BMI and type 2 diabetes mellitus, which result in an increased number of deaths.391 The 2011 secondary prevention and risk reduction therapy statement8 summarizes the key interventions known to im- prove survival and prevent subsequent cardiac events. World- wide, it has been estimated that 90% of the risk of MI is attributable to 9 measureable risk factors, including smoking, diabetes mellitus, hypertension, obesity, impaired psycholog- ical well-being, poor diet, lack of exercise, alcohol consump- tion, and dyslipidemia.392 The initial approach to all patients should be focused on eliminating unhealthy behaviors such as smoking and effectively promoting lifestyle changes (eg, maintaining a healthy weight, engaging in physical activity, adopting a healthy diet [Figure 4]). In addition, for most patients, an evidence-based set of pharmacological interven- tions is indicated to reduce the risk of future events. 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. 