Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. Smith et al AHA/ACCF Secondary Prevention: 2011 Update 2463 reasonable to treat to LDL-C ,70 mg/dL in patients at highest risk. The benefits of lipid-lowering therapy are in proportion to the reduction in LDL-C, and when LDL-C is above 100 mg/dL, an adequate dose of statin therapy should be used to achieve at least a 30% lowering of LDL-C. When the ,70 mg/dL target is chosen, it may be prudent to increase statin therapy in a graded fashion to determine a patient s response and tolerance. Further- more, if it is not possible to attain LDL-C ,70 mg/dL because of a high baseline LDL-C, it generally is possible to achieve LDL-C reductions of .50% with either statins or LDL-C lowering drug combinations. For patients with triglyceride levels $200 mg/dL, non high-density lipoprotein cholesterol values should be used as a guide to therapy. Although no studies have directly tested treatment to target strategies, the target LDL-C and non HDL-C levels are derived from several randomized controlled trials where the LDL-C levels achieved for patients showing benefit are used to suggest targets. 