For any patient, if the CAC score is 100 Agatston units or 75th percentile, statin therapy is indi- cated unless otherwise deferred by the outcome of clinician patient risk discussion. 10. Assess adherence and percentage response to LDL-C lowering medications and lifestyle changes with repeat lipid measurement 4 to 12 weeks after statin initiation or dose adjustment, repeated every 3 to 12 months as needed. Define responses to lifestyle and statin therapy by percentage reductions in LDL-C levels compared with baseline. In ASCVD patients at very high-risk, triggers for adding nonstatin drug therapy are defined by threshold LDL-C lev- els 70 mg/dL ( 1.8 mmol/L) on maximal statin therapy (see No. 3). PREAMBLE Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, which are based on systematic meth- ods to evaluate and classify evidence, provide a founda- tion for the delivery of quality cardiovascular care. The ACC and AHA sponsor the development and publica- tion of clinical practice guidelines without commercial CLINICAL STATEMENTS AND GUIDELINES support, and members volunteer their time to the writ- ing and review efforts. Clinical practice guidelines provide recommenda- tions applicable to patients with or at risk of developing cardiovascular disease (CVD). The focus is on medical practice in the United States, but these guidelines are relevant to patients throughout the world. Although guidelines may be used to inform regulatory or payer decisions, the intent is to improve quality of care and align with patients interests. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances, and should not re- place clinical judgment. 