Other risk estimators that include revascularization and additional cardiovascular endpoints provide risk estimates that cannot be compared directly with those given by the PCE. Finally, the potential for errors in estimating ASCVD risk at both ends of the risk curve (low risk and high-risk) as noted for individuals can be reviewed in the clinician patient risk discussion (Table 6). 4. The present guidelines continue to empha- size the importance of a clinician patient risk In those with a 10-year ASCVD risk of 7.5%, it is rec- ommended that the discussion occur before a statin prescription is written.S4.4.2-26 This frank discussion, as recommended in the 2013 ACC/ AHA cholesterol guidelines,S4.4.2-26 should con- sider whether ASCVD risk factors have been addressed, evaluate whether an optimal life- style has been implemented, and review the potential for statin benefit versus the potential for adverse effects and drug-drug interactions. Then, on the basis of individual characteristics and including an informed patient preference in shared decision-making, a risk decision about statin therapy can be made (Table 7). Clinicians should indicate that as ASCVD risk increases, so does benefit of evidence-based LDL-C lower- ing therapy. They may wish to review the drug and safety sections of the present guideline and stay informed on safety information that is essential for a balanced discussion. Importantly, for those at intermediate-risk, especially those >55 years of age, risk-enhancing factors or CAC can be used to clarify risk if the risk decision is Risk-enhancing factors, such as family history of premature ASCVD or an LDL-C of 160 to 189 mg/dL (4.1 4.8 mmol/L), identify Table 7. Checklist for Clinician Patient Shared Decision-Making for Initiating Therapy Checklist Item Recommendation ASCVD risk assessment Assign to statin treatment group; use ASCVD Risk Estimator Plus.