Clinicians do not follow guidelines for many and cholesterol guideline implementation has not been optimal.S6-10 S6-13 Interventions aimed at the clinician may improve guideline implemen- tation. Educational outreach or academic detailing visits are generally effective for improving process- of-care, clinical, cost-reduction, and cost-effec- Audits of individual clinical performance and feedback are generally effective in improving process-of-care and clinical outcomes.S6-5 Reminders and individual pay-for-performance are generally effective for cost reduction.S6-5 Even if guideline-directed management and therapy are prescribed, patients may be nonadher- ent or not get the prescribed medication for a vari- ety of reasons.S6-14 Patients who are initially adherent to statin therapy may not demonstrate long-term Adherent patients, with and without clinical ASCVD, have improved outcomes and reduced costs.S6-15,S6-17 S6-20 Formulary restrictions and prior authorization requirements have been associated with care delays and nonadherence.S6-21 Interventions aimed at the patient may improve adherence and clinical outcomes. Guideline implementation strategies that are aimed at the patient, clinician, health system, and health plan are needed. Barriers to guideline CLINICAL STATEMENTS AND GUIDELINES implementation should be analyzed in advance, and implementation strategies should be tailored to the setting and target audience. Multiple strat- egies may be needed to effectively implement (Table S7 in the Web Supplement). 3. Patients who participate in shared decision-making may have better health outcomes, better health- care experiences, and lower costs.S6-7,S6-8 During the clinician patient risk discussion with shared decision-making, the patient participates with the clinician in deciding lifestyle modifications, medica- tion treatment, and goals of therapy. The clinician should explain the patient s risk of clinical ASCVD and how the treatment recommendations reduce ASCVD risk. 