Coronary heart disease is one of the major causes of health problem across the globe. Saudi Arabia has a high prevalence of the disease, especially among populations living in urban areas. The main risk factor evaluated for the prevalence of the disease includes age gender, body mass index, medical history, and behaviors. Effective prevention is dependent on physicians’ awareness as well as familiarity with the guidelines for successful implementation. Research studies show, however, the existence of a gap between the understanding of these guidelines and clinical customs in preventing coronary heart disease. As a result, the Saudi population is considered to be at a high risk of an epidemic, calling for immediate action. The research focuses on assessing Saudi family physicians’ knowledge of the guidelines in secondary prevention of coronary heart disease and linking it to the disease prevalence in the kingdom. The study established that there is generally poor knowledge of secondary prevention guidelines among Saudi family physicians. The finding was evident from the prescription of drugs with adverse effects to patients as well as poor guidelines on patient adherence to secondary prevention that is offered by the physicians.