The literature comparing high- and moderate-dose statins for secondary prevention suggests the increased harms of higher dose statins. Given the lack of evidence of added benefit with higher dose statins, the Work Group determined the increased risks outweigh unproven benefits, although patient preferences may vary significantly on this decision. Thus, the Work Group decided on a Weak against recommendation. More research is needed on the effectiveness of high-dose statins for primary prevention in comparison to moderate-dose statins. This research should consist of direct comparisons between moderate- and high- dose statins in similar populations. These populations should be stratified by CV risk scoring. Recommendation 9. For primary prevention, there is insufficient evidence to recommend for or against using ezetimibe with or without statins. (Neither for nor against | Reviewed, New-replaced) Discussion This CPG s systematic evidence review yielded insufficient evidence related to ezetimibe monotherapy for primary prevention. There was one relevant meta-analysis of 13 trials from the 2014 VA/DoD Dyslipidemia CPG systematic evidence review and a single subsequent trial not included in the meta-analysis.[64,65] All of this evidence compared the addition of ezetimibe to statins with increasing the statin dose in primary prevention patients. Outcomes were limited to patient safety and surrogate outcome measures (e.g., LDL- C lowering). The Study of Heart and Renal Protection (SHARP) by Baigent et al. (2011) was not included in either the current or previous systematic evidence review and, thus, was not considered in determining the strength of this recommendation.[66] This study evaluated ezetimibe for primary prevention by comparing an ezetimibe-simvastatin combination to placebo in patients with CKD. It found significant reductions in the primary composite outcome of major atherosclerotic events (e.g.