The American Heart Association requests that this document be cited as follows: Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1082 e1143. DOI: 10.1161/CIR.0000000000000625. Key Words: AHA Scientific Statements Guidelines biomarkers, coronary artery calcium score pharmacological cardiovascular disease cholesterol, LDL-cholesterol diabetes mellitus drug therapy hydroxymethylglutaryl- CoA reductase inhibitors/statins hypercholesterolemia lipids patient compliance primary prevention risk assessment risk reduction discussion risk treatment discussion, secondary prevention ezetimibe proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9) inhibitors CLINICAL STATEMENTS AND GUIDELINES TABLE OF CONTENTS Top 10 Take-Home Messages to Reduce Risk of Atherosclerotic Cardiovascular Disease Through Cholesterol Management e1083 Preamble e1084 1. Introduction e1085 1.1. Methodology and Evidence Review e1085 1.2. Organization of the Writing Committee e1086 1.3. Document Review and Approval e1086 1.4. Scope of the Guideline e1086 1.5. Class of Recommendation and Level of Evidence e1087 1.6. Abbreviations e1087 2. High Blood Cholesterol and ASCVD e1087 2.1. Serum Cholesterol, Lipoproteins, and ASCVD e1087 2.1.1. Cholesterol, Lipoproteins, and Apolipoprotein B e1087 2.1.2. Cholesterol, LDL-C, and ASCVD e1087 2.1.3. LDL-C and Other Risk Factors e1087 2.2. Measurements of LDL-C and Non HDL-C e1088 2.3. Measurements of Apolipoprotein B and Lipoprotein (a) e1089 2.4. Monitoring Response of LDL-C to Statin Therapy e1090 3. Therapeutic Modalities e1090 3.1. Lifestyle Therapies e1090 3.1.1. Diet Composition, Weight Control, and Physical Activity e1090 3.1.2. Lifestyle Therapies and Metabolic Syndrome e1090 3.2. Lipid-Lowering Drugs e1090 3.2.1. Statin Therapy e1090 3.2.2. 