There are clear pathophysiological grounds for modulating the sympathetic nervous system in coronary artery disease. The tools are primarily pharmacologic: β-blockers have been validated in multiple prospective controlled trials and are now recommended on the basis of the best possible evidence by numerous cardiology societies in many settings; their use benefits virtually all patients and has multiple targets. Trials with newer agents, eg, ivabradine, are ongoing. The main nonpharmacologic approach is comprehensive cardiac rehabilitation: exercise programs directly impact major risk factors for cardiac death, such as heart rate variability. However, the quality of guideline implementation fails to match the quality of the supporting evidence: fewer than half of eligible patients actually receive the recommended therapies. Closing this gap is now the main challenge for clinicians...