Safety data for fiber, garlic, ginger, and green tea was inconclusive.[101-106] Patient and provider values and preferences likely vary based on personal beliefs about efficacy and safety and the ability to pay for supplements, which are generally not covered by health plans. Thus, the Work Group decided upon a Neither for nor against recommendation. d. Monitoring and Adherence Recommendation 22. We suggest against the routine monitoring of lipid levels in patients taking statins. (Weak against | Reviewed, New-replaced) Discussion Among dyslipidemic patients at high risk of CVD, we suggest against frequently monitoring lipid levels in patients taking statins, except for higher risk secondary prevention in patients for whom therapy could be intensified. No studies included in the systematic evidence review directly compared pharmacologic treatment of high lipid levels by titrating medications to reach target LDL-C or non-HDL-C goals versus fixed-dose treatment based on initial CV risk assessment and standard medication dosing. Therefore, the comparative effectiveness and safety of treating to reach specific LDL-C or non-HDL-C goals versus use of fixed statin doses based on initial CV risk assessment can only be determined indirectly at best. Several systematic reviews and meta-analyses have evaluated the association between more intensive LDL-C lowering and risk of stroke,[109] CVD,[110-112] and DM,[109,113] but all these reviews evaluated trials that modified treatment intensity instead of targeting LDL-C. They did find that a lower LDL-C level was associated with reduced CVD mortality and any stroke, ischemic stroke, hemorrhagic stroke, or CV event outcomes compared to those that had higher levels (i.e., received placebo or less intensive LDL- lowering treatment). Given that statins reduce LDL-C levels, these results indirectly demonstrate that treatment which reduces LDL levels is better than no treatment or less intensive LDL-lowering treatment (i.e., high intensity treatment is better). 