f. Level of high density lipoprotein cholesterol (HDL-C) (Less than 40 mg/dL confirmed on more than one occasion) Modified from the 2006 CPG without an updated systematic review of the evidence.* Weak for Not reviewed, Deleted We suggest against the routine use of high-sensitivity C-reactive protein (hsCRP) testing. Weak against Reviewed, New- replaced 6 21 We suggest against the routine use of coronary artery calcium (CAC) testing. Weak against Reviewed, Not Changed Recommendation Number Page 2014 Recommendation Text 2014 Strength of Recommendation Recommendation Category Recommendation We suggest shared decision making regarding pharmacologic treatment for patients with an estimated 10-year CVD risk of 12% or greater that takes into consideration the known minimal harms and substantial benefits of moderate- dose therapy in this group of patients. Weak for Reviewed, New- replaced We suggest initiation of a moderate-dose statin for patients with an estimated 10-year CVD risk of 12% or greater. Weak for Reviewed, New- replaced We suggest considering a moderate-dose statin for patients with a 10-year CVD risk between 6% and 12% following a discussion of the known minimal harms, benefits derived from limited evidence, and an exploration of the patient s values and preferences. Weak for Reviewed, New- replaced For primary prevention, we recommend a moderate dose statin as the agent of choice to reduce CVD risk if the patient chooses pharmacologic therapy. Strong for Reviewed, New- replaced Recommendations For primary prevention in patients who are unable to tolerate statins, we suggest reinforcing adherence to positive lifestyle changes. For patients who prefer to try pharmacotherapy, we suggest considering treatment with gemfibrozil or bile acid sequestrants (BAS), noting that these agents have been associated with only a small CVD risk reduction and studied in limited populations, e.g., males with low density lipoprotein cholesterol (LDL C) >190 mg/dL. 