In such patients, it may be reasonable to use LDL-C lowering drugs that have been proven safe and effective in RCTs, either as monotherapy or combined with a statin.S4.4.2-9 One alternative is a cholesterol absorption inhibitor. An RCT in adults 40 years of age with advanced CKD and without known CHD at baseline found that the addition of ezetimibe to a moderate-intensity statin lowered LDL-C 43 mg/dL (1.1 mmol/L) After a median 4.9 years, ezeti- mibe and simvastatin 40 mg per day resulted in a 17% proportional reduction in major athero- sclerotic events compared with placebo.S4.4.2-2 Another alternative is a nonsystemic bile acid sequestrant. Bile acid sequestrants used as mono- therapy reduced CHD endpoints in a large pri- Bile acid sequestrants can bind other drugs, so other medications must be avoided for 1 hour before and at least 3 to 4 hours after administration. Adding psyllium can minimize constipation and can reduce the bile acid sequestrant dose.S4.4.2-56 These therapies should be considered in the context of a risk dis- cussion that reviews potential for benefit along with tolerability and safety issues. 9. Benefit from statin therapy is seen in lower-risk Consideration of enhancing factors in selected younger individuals in this lower risk range, will improve the ability to detect younger patients who develop MI before age 50 Nonetheless, the challenge among those in a lower ASCVD risk category is to include those who would benefit yet avoid cast- ing too wide a net, to minimize treating those who would derive little benefit from statin assign- ment. This risk group benefits greatly from a clini- cian patient risk discussion. 