COR LOE Recommendations I A In patients who are 75 years of age or younger with clinical ASCVD,* high- intensity statin therapy should be initiated or continued with the aim of achieving a 50% or greater reduction in LDL-C levels.S4.1-1 S4.1-5 I A In patients with clinical ASCVD in whom high-intensity statin therapy is contraindicated or who experience statin-associated side effects, moderate- intensity statin therapy should be initiated or continued with the aim of achieving a 30% to 49% reduction in LDL-C I B-NR In patients with clinical ASCVD who are judged to be very high risk and considered for PCSK9 inhibitor therapy, maximally tolerated LDL-C lowering therapy should include maximally tolerated statin therapy IIa ASR In patients with clinical ASCVD who are judged to be very high risk and who are on maximally tolerated LDL-C lowering therapy with LDL-C 70 mg/dL or higher ( 1.8 mmol/L) or a non HDL-C level of 100 mg/dL or higher ( 2.6 mmol/L), it is reasonable to add a PCSK9 inhibitor following a clinician patient discussion about the net benefit, safety, and cost.S4.1-15 S4.1-19 IIa B-R In patients with clinical ASCVD who are on maximally tolerated statin therapy and are judged to be at very high risk and have an LDL-C level of 70 mg/dL or higher ( 1.8 mmol/L), it is reasonable to add ezetimibe Table 3. High-, Moderate-, and Low-Intensity Statin Therapy* High Intensity Moderate Intensity Low Intensity LDL-C lowering Statins Atorvastatin mg (40 mg) Atorvastatin 10 mg Rosuvastatin (5 mg) mg Simvastatin Pravastatin 40 mg Lovastatin 40 mg Fluvastatin XL 80 mg Fluvastatin 40 mg BID Pitavastatin 1 4 mg Pravastatin mg Fluvastatin Percent LDL-C reductions with the primary statin medications used in clinical practice (atorvastatin, rosuvastatin, simvastatin) were estimated using the median reduction in LDL-C from the VOYAGER database.S3.2.1-2 Reductions in LDL-C for other statin medications (fluvastatin, lovastatin, pitavastatin, pravastatin) were identified according to FDA-approved product labeling in adults with hyperlipidemia, primary hypercholesterolemia, and Boldface type indicates specific statins and doses that were evaluated in RCTs,S3.2.1-3,S3.2.1-5 S3.2.1-16 and the Cholesterol Treatment All these RCTs demonstrated a reduction in major cardiovascular events. 