The European Society of Cardiology Guidelines on the diagnosis and management of chronic coronary syndromes (2019) emphasize the crucial role of healthy lifestyle behaviours and other preventive actions in decreasing the risk of subsequent cardiovascular events and mortality. In asymptomatic subjects over 40 yo, without evidence of cardiovascular disease, diabetes, chronic kidney disease or familial hypercholesterolemia, the screening for coronary artery disease should start by calculation of the SCORE risk. The guidelines have been revised to focus on chronic coronary syndrome instead of coronary artery disease. This change emphasizes the fact that the clinical presentations of coronary artery disease can be categorized as either acute coronary syndrome or chronic coronary syndrome. Coronary artery disease is a dynamic process of atherosclerotic plaque accumulation and functional alterations of coronary circulation that can be modified by lifestyle, pharmacological treatment, and revascularization, which result in disease stabilization or regression. Patients with coronary artery disease may experience acute events or suffer from disease progression during their lifetime. For recently diagnosed chronic coronary syndrome patients, more frequent assessment and risk evaluation is required. Regarding the treatment, it evolved from a standard “first-second line” approach to a “stepwise, patient-tailored” approach. The “Diamond” approach takes comorbidities and pathophysiology as the key determining factors for the choices of anti-anginal drugs.