The Precision CAD Trial

"* Sedentary lifestyle: Advise increasing exercise to at least 30 minutes of moderate-intensity aerobic activity 5 days a week.~* Overweight/Obese: Advise calorie reduction, dietician consultation.~* Smoking: standard smoking cessation advice and literature and medical therapy as indicated to include Wellbutrin, nicotine patch etc.~* High LDL cholesterol: a) Start high dose statin if patient not on high dose statin.~ b) If on high dose statin, add ezetimibe 10mg daily c) If statin intolerant, start ezetimibe 10mg, colestid or other bile sequestrant combination.~ d) If still not at goal, start PCSK-9 inhibitor e) LDL cut off of \<55mg/dl in diabetes~* Blood Pressure optimization treatment following 2020 International Society of Hypertension Global Hypertension Practice Guidelines.~* Diabetes management: HbA1c goal 6.5%"

Participants will receive standard of care therapy prescribed by their primary care physician and/or cardiologist.

Participants with BRS of 0 will get measurements of BRS at the time-points specified for the randomized subjects and also for adverse events.