Recommendations for Adults With High Blood Cholesterol (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES 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 Primary ASCVD prevention requires attention to AS- CVD risk factors beginning early in life (Figure 3). The benefit from statin therapy is related to both global risk and intensity of treatment,S4.3-2 and no RCTs of high- intensity statin therapy have been carried out in cohorts of patients exclusively with diabetes. On the basis of these considerations and the fact that patients with dia- betes have a higher trajectory of lifetime risk than do those without diabetes, high-intensity statin therapy is preferred in patients with diabetes as they develop risk modifiers (Table 5). 