For very high-risk patients with ASCVD (eg, those with a recent myocardial infarction or unstable angina or with high-risk comorbidities such as diabetes), a LDL-C level > 70 mg / dL (> 1.2 mmol / L) despite maximal statin therapy should prompt the addition of ezetimibe or a PCSK9 inhibitor (eg, evolocumab, alirocumab).