Large absolute LDL-C reduction was associated with a larger proportional reduc- tion in major vascular events.S4.1-4 High-intensity statin therapy generally reduces LDL-C levels by 50%. This percentage can be used to judge clinical efficacy. Absolute benefit from statin ther- apy depends on baseline LDL-C levels; the great- est absolute benefit accrues to patients with the highest baseline LDL-C levels. Percentage reduc- tion of LDL-C levels is the most efficient means to estimate expected efficacy. An alternative to evaluating adequacy of therapy is to examine LDL-C on maximum-intensity statins. In a patient with ASCVD, if LDL-C level is 70 mg/dL ( 1.8 mmol/L), adding ezetimibe may be reasonable (see Recommendation 3). 2. Moderate-intensity statin therapy also reduces major vascular events and coronary heart disease (CHD) deaths in patients with ASCVD.S4.1-6,S4.1-7, In RCTs, most of which included moderate-intensity statin therapy, there was a significant reduction in major vascular events even among those >75 years of age. Therefore, an upper age cutoff for moderate-intensity statin therapy was not identified in patients with ASCVD. 3. Patients with clinical ASCVD who are judged to be very high risk include those with a history of multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions (Table 4). In these patients, additional net benefit from fur- ther LDL-C lowering when LDL-C is 70 mg/dL mmol/L) by ezetimibe and 2 PCSK9 inhibitors (evolocumab and alirocumab) has been dem- This guide- line makes a strong recommendation (COR I) Recommendations for Statin Therapy Use in Patients With ASCVD (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES for clinicians to add ezetimibe to maximally tolerated statin therapy as a first step in lower- ing LDL-C further. 