If the answer is No to Box 2, then Box 4, in the shape of a hexagon, asks the question: Does patient have higher risk CVD? (see Sidebar 2) i. If the answer is Yes to Box 4, then Box 5, in the shape of a rectangle: Recommend stepped intensification: 1. Maximize statin or add ezetimibe 2. Consider PCSK9 inhibitor only after maximizing statin and adding ezetimibe 1) Box 5 connects to Box 10, in the shape of a rectangle: If MI, ACS, or CABG/PCI in past 6 weeks, refer for cardiac rehab 2) Box 10 connects to Box 11, in the shape of a rectangle: Recommend dietitian-led Mediterranean diet for risk >12% 3) Box 11 connects to Box 12, in the shape of a rectangle: Recommend regular aerobic exercise(Suggest regular aerobic activity of any intensity or duration. Although incremental benefit is associated with increased doses of physical activity, lower doses including leisure time activity [i.e., walking, landscaping, washing dishes] are associated with benefit when compared to mostly sedentary behavior. A provider s considerations when recommending physical activity might include a patient s motivation, functional capacity, and physical activity preferences.) and smoking cessation (if applicable) 4) Box 12 connects to Box 13, in the shape of a rectangle: Follow up evaluation: 1. Primary prevention, no statin: Lipids every 10 years, recommend non- fasting; Repeat risk evaluation at Box 1: Every 2 years if 6 12%, Every 5 years if <6%, If risk factors change. 2. Secondary prevention: lipids as needed only if higher risk and willing to intensify; 3. Once on optimal therapy, no need to recheck lipids routinely ii. 