Forty percent blockage in the coronary artery, if evaluated carefully, should not lead to ischemia or symptoms of angina. However, persons with this kind of disease need very aggressive preventive strategies which include drugs like aspirin, angotensin converting enzyme (ACE) inhibitors and statins, doses depending upon the lipid levels and blood pressure etc. These agents should be taken under medical supervision. Besides this, exercise programmes and low fat diet is very important. A periodic evaluation (may be yearly) using TMT or exercise echo also helps in monitoring the progress.