The common use of this technique is tempered by the limited effect of lipid levels on risk. Alternatively, it may be useful for the provider to posit an improvement in lipid levels and show the limited effect on risk scores to illustrate the reasons for recommending statins. As this is a Reviewed, New-added recommendation, the Work Group systematically reviewed evidence related to this recommendation.[21-23] The Work Group s confidence in the quality of evidence was low. The body of evidence had some limitations (e.g., poor study designs).[21,22] Major concerns about the frequency of lipid testing included cost, judicious use of healthcare resources, and lack of patient benefit from frequent testing. The risk from more frequent lipid panels (i.e., over-diagnosis) outweighed any potential benefit of refining risk assessment, especially given the minor effect of lipid levels on risk score. The Work Group anticipated large variation in patient values and preferences since some expect and/or desire frequent testing. Thus, the Work Group decided upon a Weak against recommendation. More research is needed on the optimal frequency of lipid testing in primary prevention among individuals not on statin therapy. Recommendation 3. For cardiovascular risk assessment in primary prevention, we suggest using a 10-year risk calculator. (Weak for | Reviewed, Amended) Discussion Two systematic reviews and 11 model performance studies evaluated various methods to stratify CV risk for primary prevention patients. The equations included the FRS, Pooled Cohort Equations (PCE), version two of the QRISK cardiovascular disease risk algorithm (QRISK 2), SCORE, Progetto Cuore Score, and Reynolds Risk Score.[24-27] The Veterans Affairs Risk Score for Cardiovascular Disease (VARS-CVD) is an option to calculate a five-year risk using the fully calibrated version to improve the accuracy of the CVD risk estimation.