As the Work Group members drafted clinical practice recommendations, they also assigned a rating for each recommendation based on a modified GRADE and USPSTF methodology. Each recommendation was rated by assessing the quality of the overall evidence base, the associated benefits and harms, the variation in values and preferences, and other implications of the recommendation. In addition to developing recommendations, the Work Group also revised the 2014 VA/DoD Dyslipidemia CPG algorithm to reflect the new and amended recommendations. To update the algorithms, they discussed the available evidence and changes in clinical practice since 2014. D. Grading Recommendations This CPG uses the GRADE methodology to assess the quality of the evidence base and assign a strength for each recommendation. The GRADE system uses the following four domains to assess the strength of each Balance of desirable and undesirable outcomes Confidence in the quality of the evidence Values and preferences Other implications, as appropriate, e.g.,: Resource use Equity Acceptability Feasibility Subgroup considerations The following sections further describe each domain. Balance of desirable and undesirable outcomes refers to the size of anticipated benefits (e.g., increased longevity, reduction in morbid event, resolution of symptoms, improved quality of life, decreased resource use) and harms (e.g., decreased longevity, immediate serious complications, adverse event, impaired quality of life, increased resource use, inconvenience/hassle) relative to each other. This domain is based on the understanding that the majority of clinicians will offer patients therapeutic or preventive measures as long as the advantages of the intervention exceed the risks and adverse effects. The certainty or uncertainty of the clinician about the risk-benefit balance will greatly influence the strength of the recommendation. 