Please refer to these guidelines for contraindications to high-intensity statin therapy and recommendations for moderate-intensity statin therapy. Very high risk includes a history of multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions: Major ASCVD Events: Recent acute coronary syndrome (within the past 12 months) History of MI (other than recent acute coronary syndrome event listed above) History of ischemic stroke Symptomatic peripheral arterial disease (history of claudication with ankle-brachial index <0.85, or previous revascularization or amputation. High-Risk Conditions: Age 65 years Heterozygous familial hypercholesterolemia History of prior coronary artery bypass surgery or percutaneous coronary intervention outside of the major ASCVD events Diabetes mellitus Hypertension Chronic kidney disease (estimated glomerular filtration rate 15 59 mL min 1 ) Current smoking 6.8.2. Choice of Lipid-lowering Drugs for Patients with Clinical ASCVD* (Continued) COR LOE New, Revised, or Unchanged Powers et al 2019 Guidelines for Management of AIS e397 6.8.3 Implementation COR LOE New, Revised, or Unchanged A clinician-patient risk discussion is recommended before initiation of statin therapy to review net clinical benefit, weighing the potential for ASCVD risk reduction against the potential for statin-associated side effects, statin-drug interactions, and safety, while emphasizing that side effects can be addressed successfully. I A Recommendation unchanged from 2018 Cholesterol Guidelines. In patients with indication for statin therapy, identification of potential predisposing factors for statin-associated side effects, including new-onset diabetes mellitus and statin-associated muscle symptoms, is recommended before initiation of treatment. I B-R Recommendation unchanged from 2018 Cholesterol Guidelines. In patients with statin-associated side effects that are not severe, it is recommended to reassess and to rechallenge to achieve a maximal LDL-C lowering by modified dosing regimen, an alternate statin or in combination with nonstatin therapy. I B-R Recommendation unchanged from 2018 Cholesterol Guidelines. 