Recommendations for Adults With High Blood Cholesterol Referenced studies that support recommendations are summarized in Online Data Supplements 11 and 12. COR LOE Recommendations I A In adults at intermediate risk ( 7.5% to <20% 10-year ASCVD risk), statin therapy reduces risk of ASCVD, and in the context of a risk discussion, if a decision is made for statin therapy, a moderate-intensity statin should be recommended.S4.3-2 S4.3-9 Adapted from recommendations in the 2018 Cholesterol Clinical Practice Guidelines.S4.3-1 I A ASCVD risk) patients, LDL-C levels should be reduced by 30% or more, and for optimal ASCVD risk reduction, especially in patients at high risk ( 20% 10-year ASCVD risk), levels should be reduced by 50% or more.S4.3-2,S4.3-5 S4.3-10 Adapted from recommendations in the 2018 Cholesterol Clinical Practice Guidelines.S4.3-1 I A In adults 40 to 75 years of age with diabetes, regardless of estimated 10-year ASCVD risk, moderate-intensity statin therapy is indicated.S4.3-11 S4.3-19 Included from recommendations in the 2018 Cholesterol Clinical Practice Guidelines.S4.3-1 I B-R In patients 20 to 75 years of age with an LDL-C level of 190 mg/dL ( 4.9 mmol/L) or higher, maximally tolerated statin therapy is Included from recommendations in the 2018 Cholesterol Clinical Practice Guidelines.S4.3-1 IIa B-R In adults with diabetes mellitus who have multiple ASCVD risk factors, it is reasonable to prescribe high-intensity statin therapy with the aim to reduce LDL-C levels by 50% Included from recommendations in the 2018 Cholesterol Clinical Practice Guidelines.S4.3-1 IIa B-R year ASCVD risk) adults, risk-enhancing factors favor initiation or intensification of Adapted from recommendations in the 2018 Cholesterol Clinical Practice Guidelines.S4.3-1 IIa B-NR ASCVD risk) adults or selected borderline-risk in whom a coronary artery calcium score is measured for the purpose of making a treatment decision, AND If the coronary artery calcium score is zero, it is reasonable to withhold statin therapy and reassess in 5 to 10 years, as long as higher-risk conditions are absent (eg, diabetes, family history of premature CHD, cigarette smoking); If coronary artery calcium score is 1 to 99, it is reasonable to initiate statin therapy for patients 55 years of age; If coronary artery calcium score is 100 or higher or in the 75th percentile or higher, it is reasonable to initiate statin therapy.S4.3-28,S4.3-34 Adapted from recommendations in the 2018 Cholesterol Clinical Practice Guidelines.S4.3-1 IIb B-R In patients at borderline risk (5% to <7.5% 10- year ASCVD risk), in risk discussion, the presence of risk-enhancing factors may justify initiation of moderate-intensity statin therapy.S4.3-28,S4.3-35 Adapted from recommendations in the 2018 Cholesterol Clinical Practice Guidelines.S4.3-1 CLINICAL STATEMENTS AND GUIDELINES Synopsis Primary ASCVD prevention requires attention to AS- CVD risk factors beginning early in life (Figure 3). 