For secondary prevention, we suggest offering icosapent ethyl in patients on statin therapy with persistently elevated fasting triglycerides >150 mg/dL to reduce cardiovascular morbidity and mortality. Not applicable [99] Weak for Reviewed, New- added 20. For primary or secondary prevention, we suggest against the use of omega-3 fatty acids as a dietary supplement to reduce cardiovascular disease risk. Not applicable [100] Weak against Reviewed, New- added 21. There is insufficient evidence to recommend for or against the use of fiber, garlic, ginger, green tea, and red yeast rice supplements to reduce cardiovascular risk. Not applicable [101-106] Additional references: Neither for nor against Reviewed, New- added 22. We suggest against the routine monitoring of lipid levels in patients taking statins. Strong against [109-113] Additional references: Weak against Reviewed, New- replaced 23. For patients who cannot tolerate a statin, we suggest a washout period followed by a re-challenge with the same or a different statin or lower dose, and if that fails, a trial of intermittent (nondaily) dosing. Not applicable [56,114,116,119,120] Additional references: Weak for Reviewed, New- added 24. We suggest offering intensified patient care (e.g., phone calls, emails, patient education, drug regimen simplification) to improve adherence to lipid-lowering medications. Not applicable [121] Additional references: Weak for Reviewed, New- added Recommendation 2014 Strength of Recommendation Evidence 2020 Strength of Recommendation Recommendation Category 25. For primary and secondary prevention of cardiovascular disease, we suggest a dietitian-led Mediterranean diet. Weak for, Weak for [128,129] Additional references: Weak for Reviewed, New- replaced 26. For primary and secondary prevention of cardiovascular disease, we suggest regular aerobic physical activity of any intensity and duration. Not applicable [134-142] Additional references: Weak for Reviewed, New- added 27. We recommend a structured, exercise-based cardiac rehabilitation program for patients with recent occurrence of coronary heart disease (i.e.