Which medication class is most important for reducing mortality in coronary artery disease?

• A. ACE inhibitor
• B. Beta-blocker
• C. Statin
• D. Nitrates

Answer: (B)

Statins are the cornerstone for lowering mortality in coronary artery disease. They reduce LDL cholesterol, which slows atherosclerotic plaque progression, promotes plaque stabilization, improves endothelial function, and has anti-inflammatory effects. Large trials in people with established CAD consistently show fewer deaths and fewer major cardiovascular events with statin therapy, across a range of risk profiles.

Beta-blockers do reduce mortality, especially after a myocardial infarction and in patients with ongoing ischemia or left ventricular dysfunction, but their mortality benefit is most pronounced in the post‑MI or heart failure setting rather than across all stable CAD patients. ACE inhibitors also reduce mortality mainly in patients with hypertension, LV dysfunction, or heart failure. Nitrates improve symptoms but have not shown the same broad mortality reduction as statins.

So, the medication class with the most robust impact on survival in CAD is statins.