Patients with coronary heart disease are at high risk for myocardial infarction and sudden death. The secondary prevention of acute coronary events will require interrupting the atherosclerotic process through risk-factor modification. Hyperlipidemia, hypertension, and cigarette smoking are discussed as powerful but modifiable risk factors. Primary and secondary prevention studies of lipid-lowering therapy, antihypertensive therapy, and smoking cessation are reviewed. Specific treatment recommendations are made for the coronary disease patient with hyperlipidemia, hypertension, or cigarette addiction.