Angina pectoris, a common manifestation of stable ischemic heart disease, is a common problem that continues to grow in our society, given the aging population, the epidemic of obesity, and resultant cardiovascular risk factors. This article focuses on the pathophysiology of this disease, its epidemiology, and the goals of therapy. Although angina pectoris can present in many different ways (eg, typical, atypical, silent), correct identification requires thoughtful assessment and evaluation. It is clear that our focus in the prevention of coronary artery disease by addressing modifiable risk factors is of paramount importance. However, patients often present to physicians because of symptoms and their satisfaction with their care is often dictated by the effectiveness of the treatment for this presentation. It also requires a tailored approach, recognizing that (except in higher-risk scenarios) pharmacologic agents should be the first-line approach to treatment. The availability of newer first-line agents such as ranolazine should allow an effective trial of optimal medical therapy, which, incidentally, forms the cornerstone of many of the appropriateness criteria for revascularization for coronary disease. Coronary revascularization, either by percutaneous coronary intervention or by bypass surgery, is a reasonable option in patients whose symptoms are not adequately controlled with medical therapy alone or in those with high-risk characteristics. Even with revascularization, significant numbers of patients will continue to have (or develop over time) anginal symptoms requiring medical treatment.