Available evidence, however, does not sup- port the use of coenzyme Q10 supplementation for routine use in patients treated with statins or for the treatment of SAMS.S5-20,S5-21 10. The majority of SAMS are subjective myalgia in the absence of other findings,S5-3,S5-13,S5-14,S5-23,S5-30 and an asymptomatic increase in transaminases (>3 times upper limit of normal) is an infrequent statin-associated side effect.S5-1,S5-22,S5-24 Therefore, CK and transaminase levels should not be rou- tinely measured given the unlikely impact on clinical outcomes, and the lack of established cost Recommendations for Implementation Referenced studies that support recommendations are summarized in Online Data Supplements 42 to 46. COR LOE Recommendations I A Interventions focused on improving adherence to prescribed therapy are recommended for management of adults with elevated cholesterol levels, including telephone reminders, calendar reminders, integrated multidisciplinary educational activities, and pharmacist-led interventions, such as simplification of the drug regimen to I B-NR Clinicians, health systems, and health plans should identify patients who are not receiving guideline-directed medical therapy and should facilitate the initiation of appropriate guideline-directed medical therapy, using multifaceted strategies to improve guideline implementation.S6-5,S6-6 I B-NR Before therapy is prescribed, a patient- clinician discussion should take place to promote shared decision-making and should include the potential for ASCVD risk- reduction benefit, adverse effects, drug-drug interactions, and patient preferences.S6-7,S6-8 Synopsis Guideline publication does not guarantee guideline implementation. Healthcare delivery is complex, and barriers to guideline implementation can occur at the patient, clinician, health system, and health plan levels, leading to gaps in care. A more concerted effort, with multifaceted strategies aimed at the patient, clinician, health system, and health plan, is needed to overcome the barriers and achieve wider guideline implementa- tion (Table S7). 