An adequate dose of statin should be used that reduces LDL-C to ,100 mg/dL AND achieves at least a 30% lowering of LDL-C.25 29 (Level of Evidence: C) 6. Patients who have triglycerides $200 mg/dL should be treated with statins to lower non HDL-C to ,130 mg/dL.25 27,30 (Level of Evidence: B) 7. Patients who have triglycerides .500 mg/dL should be started on fibrate therapy in addition to statin therapy to prevent acute pancreatitis. (Level of Evidence: C) Class IIa 1. If treatment with a statin (including trials of higher-dose statins and higher-potency statins) does not achieve the goal selected for a patient, intensification of LDL-C lowering drug therapy with a bile acid sequestrant or niacin is reasonable.31 33 (Level of Evidence: B) 2. For patients who do not tolerate statins, LDL-C lowering therapy with bile acid sequestrants and/or niacin is reasonable.35,36 (Level of Evidence: B) 3. It is reasonable to treat very high-risk patients* with statin therapy to lower LDL-C to ,70 mg/dL.26 28,37,38,166 (Level of Evidence: C) 4. In patients who are at very high risk* and who have triglycerides $200 mg/dL, a non HDL-C goal of ,100 mg/dL is reasonable.25 27,30 (Level of Evidence: B) (Continued) Smith et al AHA/ACCF Secondary Prevention: 2011 Update 2459 Table 1. Continued Area for Intervention Recommendations Lipid management cont d Class IIb 1. The use of ezetimibe may be considered for patients who do not tolerate or achieve target LDL-C with statins, bile acid sequestrants, and/or niacin. (Level of Evidence: C) 2. For patients who continue to have an elevated non HDL-C while on adequate statin therapy, niacin or fibratei therapy32,35,41 (Level of Evidence: B) or fish oil (Level of Evidence: C) may be reasonable. 3. 