A 58-year-old woman with known CAD presents with stable exertional chest pain. Which pharmacologic therapy has the strongest evidence for reducing long-term mortality in stable CAD?

• A. Aspirin therapy
• B. Beta-blocker therapy
• C. High-intensity statin therapy (e.g., atorvastatin 40–80 mg daily)
• D. ACE inhibitor therapy

Answer: (C)

High-intensity statin therapy provides the strongest evidence for reducing long-term mortality in stable coronary artery disease. Lowering LDL cholesterol with a potent statin – for example, atorvastatin 40–80 mg daily – not only decreases cholesterol but also stabilizes plaques, reduces inflammation, and improves endothelial function. These effects translate into fewer fatal cardiovascular events over time, a benefit consistently shown in randomized trials and meta-analyses of patients with established CAD.

Aspirin helps prevent some nonfatal events, but its impact on mortality in this setting is smaller in comparison. Beta-blockers mainly aid symptom control and have clear mortality benefits after an acute event, but in stable CAD without prior MI or heart failure, their mortality advantage isn’t as robust. ACE inhibitors reduce mortality chiefly when there are additional indications such as hypertension, diabetes, LV dysfunction, or prior MI. Thus, high-intensity statin therapy stands out as the most impactful for long-term survival in stable CAD.