[29] Other than CAC scoring, none of the other risk markers reviewed demonstrated any additive predictive risk value to traditional risk assessment models. No prospective study has shown that incorporating any additional risk marker into CV risk assessment improves outcomes.[29,33-35] The only theoretical utility of these tests would be for intermediate risk situations where there is uncertainty about the benefit of treatment. There is no prospective evidence to validate any additional risk score method as a means of clarifying intermediate risk. Incorporating additional risk factors in CV risk assessment should occur in the context of a shared decision making framework with a clear discussion about the uncertainty in how lipid management decisions will be affected by the results. As this is a Reviewed, New-replaced recommendation, the Work Group systematically reviewed evidence related to this recommendation.[26,29,32-35] The Work Group s confidence in the quality of evidence was very low. The body of evidence had several limitations (i.e., short follow-up period, low number of outcome events per variable, and lack of adequate statistical reporting).[29,33] Some variation in patient and provider values and preferences is likely since some individuals prefer as much information as possible when determining CVD risk. Other factors influencing this recommendation included resource use (e.g., staffing, time burden), the limited benefit of additive predictive risk, and potential harms from overtreatment. Thus, the Work Group decided upon a Weak against recommendation. B. Pharmacotherapy, Supplements, and Nutraceuticals a. Primary Prevention Recommendation 6. For primary prevention, we recommend offering a moderate-dose statin in patients with a >12% 10-year cardiovascular risk or low-density lipoprotein cholesterol >190 mg/dL or diabetes. (Strong for | Reviewed, New-replaced) 7. 