Variation in patient and provider values and preferences is likely since the risk/benefit ratio is not as favorable for high-dose versus moderate-dose statins. Thus, the Work Group decided upon a Weak for recommendation. More research is needed to identify the most effective, safe approach for lowering risk for recurrent CVD events, including a comparison between maximizing statin doses and other interventions for secondary prevention. Risk stratification should be prospectively evaluated to identify patients at sufficiently high risk who would most benefit from more aggressive lipid-modifying treatment (e.g., assigning higher weight to risks like DM and PAD versus advanced age or renal impairment). Recommendation 13. For secondary prevention in higher risk patients who are willing to intensify treatment, we suggest adding ezetimibe to either moderate- or high-dose statins for reducing non-fatal cardiovascular events following a discussion of the risks, additional benefits, and an exploration of the patient s values and preferences. (Weak for | Reviewed, New-replaced) Discussion The addition of ezetimibe to moderate-dose statins in higher risk patients for secondary prevention of CV events is supported by two fair quality meta-analyses by Hong et al. (2018) [80] and Zhan et al. (2018) [81] and two fair quality studies of CV risk stratification and benefit of adding ezetimibe to statins using data from the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT).[75,76] Hong et al. (2018) included seven trials (n=28,191 [7,298 with DM]) comparing a statin plus ezetimibe versus a statin alone or placebo and stratified by the presence of DM.[80] The addition of ezetimibe to statins in patients with DM was associated with a greater reduction in CV events compared to those respectively). Zhan et al. (2018) found that ezetimibe added to statins reduced CV event risk versus a statin alone (RR: 0.94, 95% CI: 0.9 0.98).