(eg, 8.5% had major cardiovascular events in 3.8 years).S4.3-13 The benefit from statin therapy is related to both global risk and intensity of treatment,S4.3-2 and no RCTs of high-intensity statin therapy have been carried out in cohorts of patients exclusively with diabetes. On the basis of these considerations and the fact that patients with diabetes have a higher trajectory of lifetime risk than do those without diabetes, high-intensity statin therapy is preferred in patients with diabetes as they develop risk modifiers (Table 5). 6. Knowledge of risk-enhancing factors (Table 3 in Section 2.2.) is useful for all individuals but par- ticularly for those at intermediate risk (ASCVD risk of 7.5% to 20%). For example, in an RCT,S4.3-38 a family history of premature ASCVD identified women 60 years of age with elevated hsCRP and without ASCVD who benefitted from high- intensity statin therapy. Those with primary LDL-C elevations of 160 mg/dL ( 4.1 mmol/L) have CLINICAL STATEMENTS AND GUIDELINES elevated lifetime ASCVD risk and benefit from Increased ASCVD risk is seen with metabolic syndrome;S4.3-31 inflammatory diseases, including psoriasisS4.3-39 and rheumatoid arthritis; and HIV when treated with protease The presence of risk-enhancing factors may affect the threshold for statin ini- tiation or intensification. Lipoprotein (a) levels, especially in those with a family history of pre- mature ASCVD, can increase risk.S4.3-27 However, no available RCT evidence supports lipoprotein (a) levels as a target of therapy. Moderate primary elevations of triglycerides, non HDL-C (total cho- lesterol HDL-C), and, if measured, apolipopro- tein B can improve selection of those at increased 7. 