CLINICAL STATEMENTS AND GUIDELINES Kleindorfer supporting the use of ezetimibe before PCSK-9 inhibitors in patients with ischemic stroke who are not at their LDL-C targets. 4. Goals and clinical efficacy for LDL-C lowering are defined and monitored by percentage LDL-C reduc- tions relative to baseline levels. Baseline LDL-C is estimated by pretreatment measurements, chart reviews, or measurement after drug therapy is inter- rupted. Without a baseline level, response to therapy is difficult to evaluate. Adherence to LDL-lowering diets reduces LDL-C levels 10% to >15%.214 Moderate-intensity statins reduce LDL-C levels by another 30% to 49%; high-intensity statins, by 50%. Adding ezetimibe or bile acid sequestrants to statin therapy reduces LDL-C by an additional 15% to 25%. Adding a PCSK9 inhibitor to statin plus ezetimibe causes greater reductions. Lifestyle changes and statin therapy are commonly introduced together. The maximum percentage change occurs 4 to 12 weeks after therapy is started, at which time drug efficacy or initial adherence to therapy can be evaluated. Periodic remeasurements can confirm adherence to therapy. Because recommended inten- sities of drug therapies vary in adolescents, young adults, adults 40 to 75 years, those with severe hypercholesterolemia, and those treated for second- ary prevention, the recommended LDL-C levels to achieve also vary. Given the modest differences in LDL-C levels associated with the postprandial state, a nonfasting sample is effective to document base- line lipid levels before initiation of statin therapy. 4.3.2. Treatment of Hypertriglyceridemia Recommendations for Hypertriglyceridemia Referenced studies that support recommendations are summarized in online Data Supplement 13. 