The primary sources of evidence are randomized controlled trials (RCTs). Most RCTs in this area have been performed with statins as the only cholesterol-lowering drug.S1.4-1 S1.4-3 Since the 2013 ACC/AHA cholesterol guideline,S1.4-4 newer cholesterol-lowering agents (nonstatin drugs) have been introduced and subjected to RCTs. They include ezetimibe and PCSK9 inhibitors, and their use is lim- ited mainly to secondary prevention in patients at very high-risk of new atherosclerotic cardiovascular disease (ASCVD) events. Most other patients with ASCVD are treated with statins alone. In primary prevention, statins are recommended for patients with severe hy- percholesterolemia and in adults 40 to 75 years of age either with diabetes mellitus or at higher ASCVD risk. Throughout these guidelines similar to the 2013 guidelines, consistent attention is given to a clinician patient risk discussion for making shared decisions. Besides major risk factors of the pooled cohort equa- tions (PCE), the clinician patient risk discussion can in- clude other risk-enhancing factors, and when risk sta- tus is uncertain, a coronary artery calcium (CAC) score is an option to facilitate decision-making in adults 40 years of age. In children, adolescents, and young adults, identifying those with familial hypercholester- olemia (FH) is a priority. However, most attention is given to reducing lifetime ASCVD risk through lifestyle therapies. CLINICAL STATEMENTS AND GUIDELINES 1.5. Class of Recommendation and Level of Evidence Recommendations are designated with both a class of recommendation (COR) and a level of evidence (LOE). The class of recommendation indicates the strength of recommendation, encompassing the estimated magni- tude and certainty of benefit in proportion to risk. 