, 1 month), re-challenge with same or a different statin or lower dose, and if that fails, a trial of intermittent (nondaily) dosing Intensified patient care (e.g., phone calls, emails, patient education, drug regimen simplification) may improve adherence to lipid-lowering medications Statin doses listed as moderate are equivalent to moderate intensity; statin doses listed as high are equivalent to high intensity Abbreviations: BID: twice per day; mg: milligrams; XL: sustained release VI. Recommendations Topic Sub- topic # Recommendation Strengtha Categoryb Primary Prevention: Screening and Assessment of Cardiovascular Risk 1. For primary prevention in patients over age 40 and not on statin therapy who have not developed new cardiovascular risk factors (e.g., diabetes, hypertension, tobacco use), we suggest against offering a cardiovascular disease risk assessment more frequently than every five years. Weak against Reviewed, Amended 2. For primary prevention in patients not on statin therapy, we suggest against routinely ordering a lipid panel more frequently than every 10 years. Weak against Reviewed, New- added 3. For cardiovascular risk assessment in primary prevention, we suggest using a 10-year risk calculator. Weak for Reviewed, Amended 4. We suggest against the routine use of coronary artery calcium testing. Weak against Reviewed, Not changed 5. We suggest against the routine use of additional risk markers (e.g., high-sensitivity C-reactive protein, ankle-brachial index, coronary artery calcium) when assessing cardiovascular risk. Weak against Reviewed, New- replaced Pharmacotherapy, Supplements, and Nutraceuticals a. Primary Prevention 6. For primary prevention, we recommend offering a moderate- dose statin in patients with a >12% 10-year cardiovascular risk or low-density lipoprotein cholesterol >190 mg/dL or diabetes. Strong for Reviewed, New- replaced 7. 