Lifestyle Therapies and Metabolic Syndrome Lifestyle therapies are particularly indicated for the metabolic syndrome, which is a cluster of risk factors associated with an increased risk of ASCVD, diabetes mellitus, and all-cause death.S3.1.2-1,S3.1.2-2 Metabolic syndrome is a risk-enhancing factor for ASCVD. The most widely used clinical definition of metabolic syn- drome is that proposed by an international consortium of cardiovascular and diabetes organizations.S3.1.2-3 The diagnosis is made by the presence of any 3 of the fol- lowing 5 risk factors: elevated waist circumference, elevated serum triglycerides, reduced HDL-C, elevated blood pressure, and elevated fasting glucose (Table S2 in the Web Supplement). Metabolic syndrome is closely linked to excess weight and particularly to abdominal Therefore, the prevalence of metabolic syndrome has risen sharply among both adults and children as levels of overweight and obesity have risen. Metabolic syndrome is now found in approximately one-third of the adults in the United StatesS3.1.2-5 and is likely underrecognized because of insufficient rates of screening. The prevalence of metabolic syndrome in- creases with age and very commonly occurs in patients with type 2 diabetes mellitus. See Table S2 in the Web Supplement. 3.2. Lipid-Lowering Drugs Among lipid-lowering drugs, statins are the cornerstone of therapy, in addition to healthy lifestyle interventions. Other LDL-lowering drugs include ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. Triglyceride-lower- ing drugs are fibrates and niacin; they have a mild LDL- lowering action, but RCTs do not support their use as add-on drugs to statin therapy.S3.2-1 Characteristics of LDL-lowering drugs are summarized in Table S3 in the Web Supplement. 3.2.1. Statin Therapy The intensity of statin therapy is divided into 3 cat- egories: high-intensity, moderate-intensity, and low- High-intensity statin therapy typically lowers LDL-C levels by 50%, moderate-intensity statin therapy by 30% to 49%, and low-intensity statin therapy by <30% (Table 3). 