Risk-Enhancing Factors Moderate intensity generic statins allow for efficacious and cost-effective primary prevention in patients with a 10-year risk of ASCVD 7.5%.S4.4.1.3-1 Since 2013 ACC/ provided additional support for this finding. The pooled cohort equation (PCE) is the single most robust tool for esti- mating 10-year risk in US adults 40 to 75 years of age. Its strength can be explained by inclusion of major, in- dependent risk factors. One limitation on the PCE when applied to individuals is that age counts as a risk factor and dominates risk scoring with advancing age. Age is a powerful population risk factor but does not neces- sarily reflect individual risk. Another factor influencing risk are baseline characteristics of populations (baseline risk). These characteristics include both genetic and ac- quired risk factors other than established major risk fac- tors. Variation in baseline risk accounts for difference in risk in different ethnic groups. Absolute risk predictions depend on the baseline risk of a population (eg, the US population). These considerations in patients at inter- mediate risk leave room in the clinician-patient risk dis- cussion to withhold or delay initiation of statin therapy, depending on age, pattern of risk factors, and patient preferences and values. In sum, the PCE is a powerful tool to predict population risk, but it has limitations when applied to individuals. One purpose of the clinician patient risk discussion is to individualize risk status based on PCE as well as other factors that may inform risk prediction. Among these other factors are the risk- enhancing factors discussed in this guideline. These risk-enhancing factors are listed in Table 6, and evi- dence base and strength of association with ASCVD are shown in Table S6. In the general population, they may or may not predict risk independently of PCE. 