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Cardiovascular disease (CVD) remains the leading cause of mortality in the United States, causing 1 in 3 deaths, and is associated with an estimated $316 billion in health care–related costs and lost productivity. Patients with coronary artery disease (CAD), both obstructive and nonobstructive, require a comprehensive approach to optimize lifestyle and medical therapy to mitigate the effects of adverse risk factors and reduce the risk of major adverse cardiovascular events (MACEs). Statin therapy plays a key role in slowing atherosclerosis progression, stabilizing plaque, and reducing MACEs and all-cause mortality.1 In symptomatic patients, knowledge of the coronary anatomy, such as that demonstrated by coronary computed tomography angiography (CTA), has the potential to improve triaging of health care resources, with prompt ruling out of high-risk coronary anatomy (ie, left main, >50%) and allocation of preventive medications for those identified as having atherosclerotic disease. The benefits of seeing is believing were most clearly demonstrated in the SCOT-HEART trial,2 an open-label study comparing the utility of coronary CTA with usual care among patients with stable chest pain symptoms (47% of patients had established CAD at baseline). A coronary CTA–guided early diagnostic strategy resulted in a 41% relative reduction in subsequent MACEs (2.3% vs 3.9%) at 5 years.2 Patients in the coronary CTA–randomized group were 40% more likely to initiate preventive therapies compared with patients receiving usual care (hazard ratio, 1.40; 95% CI, 1.19-1.65).2 Other studies of asymptomatic patients at risk of CAD have also shown that a patient’s awareness of their coronary artery calcium (CAC) score by noncontrast CT, a measure of total atherosclerotic burden, is associated with better adherence to preventive medications and behavioral lifestyle changes.3 Each year in the United States, an estimated 8 million nuclear stress tests are performed with the goal of identifying obstructive CAD in patients with chest pain who are suspected of having myocardial ischemia. The cost-effectiveness of such a functional strategy in terms of quality-adjusted life-years (QALYs) gained is unclear. Most patients with stable CAD have few or no symptoms of angina, and most CVD events occur among individuals without angina or evidence of ischemia.4 These observations emphasize the role of a prevention-driven strategy with appropriate medical therapy rather than a symptom-driven or even ischemia-driven strategy.5 In this issue of JAMA Network Open, Karáday et al6 evaluated the short-term, mid-term, and long-term cost-effectiveness of anatomic vs functional strategies for the evaluation of stable chest pain using data from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial.7 PROMISE7 randomized 10 003 symptomatic patients (88% of patients with chest pain or dyspnea on exertion) with a mean (SD) age of 61 (8) years and pretest probability of CAD of 53% to a strategy of coronary CTA (anatomic) or stress testing (functional). Because women are more likely to have angina without obstructive CAD than men, we applaud the investigators for enrolling women as more than half (ie, 53%) of study participants. Additionally, 23% of patients belonged to minority racial or ethnic groups. The main finding of PROMISE was that the rate of the primary clinical outcome (a composite of death, myocardial infarction, unstable angina + Related article