All models agree that the value provided by PCSK9 inhibitors would be signifi- cantly improved by price reductions of 70% to 85% from the mid-2018 US list price of roughly $14000 a year. 7. When high-intensity stain therapy was compared with moderate-intensity statin therapy in patients >75 years of age with ASCVD,S4.1-3 there was no heterogeneity of effect among age groups analyses of RCTs that compared statin therapy (mostly moderate intensity) with placebo among patients >75 years of age with ASCVD showed statistically significant reduction in major vascu- Because older adults may have a higher risk of adverse events (eg, liver function test abnormalities), lower statin adherence, and Table 4. Very High-Risk* of Future ASCVD Events Major ASCVD Events Recent ACS (within the past 12 mo) History of MI (other than recent ACS event listed above) History of ischemic stroke Symptomatic peripheral arterial disease (history of claudication with ABI <0.85, or previous revascularization or amputationS4.1-40 ) High-Risk Conditions Age 65 y Heterozygous familial hypercholesterolemia History of prior coronary artery bypass surgery or percutaneous coronary intervention outside of the major ASCVD event(s) Diabetes mellitus Hypertension Current smoking Persistently elevated LDL-C (LDL-C 100 mg/dL [ 2.6 mmol/L]) despite maximally tolerated statin therapy and ezetimibe History of congestive HF *Very high-risk includes a history of multiple major ASCVD events or one major ASCVD event and multiple high-risk conditions. ABI indicates ankle-brachial index; ACS, acute coronary syndrome; ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; HF, heart failure; LDL, low-density lipoprotein cholesterol; and MI, myocardial infarction. CLINICAL STATEMENTS AND GUIDELINES higher discontinuation rates with high-intensity a moderate-intensity statin may be preferable. Nevertheless, the decision to ini- tiate moderate- or high-intensity statin therapy in patients >75 years of age with ASCVD should be based on expected benefit versus competing 8. 