Weak for Reviewed, New- replaced Recommendations 19 29 We suggest measuring LFTs 4-12 weeks after the initiation of high-dose statin. Weak for Reviewed, Deleted We recommend all adults adopt healthy lifestyles to reduce CVD risk, including: a. Tobacco cessation for all smokers (See 2008 Tobacco Use CPG, http://www.healthquality.va.gov/guidelines/cd/mtu/index.asp) b. Therapeutic Lifestyle Changes (TLC) diet to optimize nutrition (For overweight and/or obese patients, see 2014 Obesity CPG, http://www.healthquality.va.gov/guidelines/CD/obesity/VADoDCPGMana c. Optimal physical activity (See 2008 Physical Activity Guidelines for Americans, http://www.health.gov/paguidelines/pdf/paguide.pdf) Modified from the 2006 CPG without an updated systematic review of the evidence. Strong for Reviewed, Deleted We suggest offering high-risk patients (see text for definition) a dietitian- monitored Mediterranean diet supplemented with either extra-virgin olive oil (roughly 1 liter per week) or 30 grams (g) of mixed nuts per day (15g of walnuts, 7.5g of hazelnuts, and 7.5g of almonds) for the reduction of CVD events. Weak for Reviewed, New- replaced Recommendation Recommendation Number Page 2014 Recommendation Text 2014 Strength of Recommendation Recommendation Category Recommendation We suggest that each patient s diet be individualized based on a nutrition assessment (preferably by a registered dietitian [RD]), other CVD risk factors, other disease conditions, and lifestyle. Modified from the 2006 CPG without an updated systematic review of the evidence. Weak for Reviewed, Deleted We recommend treating the common secondary causes of elevated triglycerides (TGs): dietary indiscretion (e.g., refined sugars), alcohol use, hypothyroidism, and hyperglycemia. Modified from the 2006 CPG without an updated systematic review of the evidence. Strong for Reviewed, Deleted We suggest for patients with TGs greater than 500 mg/dL a strict diet therapy including avoidance of alcohol, restriction of dietary fat, and avoidance of refined sugars. We suggest for patients with TGs greater than 1000 mg/dL a very low fat diet to reduce chylomicronemia and risk of acute pancreatitis. 