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. For primary prevention, we suggest offering a moderate-dose statin for patients with a 10-year cardiovascular risk between 6% and 12% following a discussion of risks, limited benefit, and an exploration of the patient s values and preferences. (Weak for | Reviewed, New-replaced) Discussion Evidence suggests moderate-dose statins lower CV mortality, all-cause mortality, and CV events. The largest systematic review, Yebyo et al. (2019), included 40 primary prevention trials (n=94,283).[36] The summary effect size indicated a 20% relative risk reduction in all-cause mortality over one year (number needed to treat [NNT] = 908), an 11% relative risk reduction in CV mortality over one year (NNT=715), and a 26% relative risk reduction in major CV events over one year (NNT=833). A major limitation was the limited follow-up in many trials. This systematic review included a network meta-analysis that did not find a significant difference between statin drugs.[36] Although the absolute benefit of statin treatment for primary prevention is limited in the general population, the benefit becomes more substantial as time and risk levels increase. Another systematic review of primary prevention trials, Chou et al. (2016), included 19 studies (n=71,344) of adult patients with increased CVD risk and found the same effect of moderate-dose statins (i.e., reducing all-cause mortality, CV mortality and events) but with greater absolute benefits in patients at baseline higher risk.