Clinical Trials

Inclusion Criteria:

• Signs and symptoms of suspected ischemia prompting referral for further evaluation by cardiac catheterization, or coronary angiogram or coronary CT angiogram within 5 years from consent.
• Willing to provide written informed consent.
• Age ≥ 18 years old.
• Non-obstructive CAD defined as 0 to 49% diameter reduction of a major epicardial vessel or a FFR > 0.80.

Exclusion Criteria:

• History of noncompliance (with medical therapy, protocol, or follow-up).
• History of non-ischemic dilated or hypertrophic cardiomyopathy.
• Documented ACS within previous 30 days.
• LVEF < 40%, NYHA HF class III-IV, or hospitalization for HFrEF within 180 days.
• Stroke within previous 180 days or intracranial hemorrhage at any time.
• End-stage renal disease, on dialysis, or estimated glomerular filtration rate (eGFR) < 30 ml/min.
• Severe valvular disease or likely to require surgery/TVAR within 3 years.
• Life expectancy < 3 years due to non-cardiovascular comorbidity.
• Enrolled in a competing clinical trial.
• Prior intolerance to both an ACE-I and ARB.
• If intolerant to a statin unless taking a PCSK9 as a statin replacement by their clinical provider.
• Pregnancy (If they have not gone through menopause, had a hysterectomy, oophorectomy, or sterilization such as tubal ligation procedure, all pre-menopausal females must have negative urine pregnancy test if randomized to IMT before study drugs are prescribed).