As CV risk scoring influences treatment decisions and frequently involves laboratory testing, excessive monitoring may lead to unnecessary testing and/or treatments. Therefore, avoiding frequent risk assessments has the potential to optimize medical resource use, reduce costs, and enhance patient participation at checkups. Given the lack of evidence for improved health outcomes, the harms/burdens of CV risk assessment screenings more than every five years outweigh potential benefits. As this is a Reviewed, Amended recommendation, the Work Group systematically reviewed evidence related to this recommendation.[20,21] The Work Group s confidence in the quality of the evidence was low. The main study limitations were high attrition rates, differing patient characteristics between those who drop out and those who remained, and a change in lipoprotein measurement methods in one study. Thus, the Work Group decided upon a Weak against recommendation. There is a paucity of evidence about the optimal timing and frequency for CV risk assessment in specific subgroups of patients (i.e., age-, ethnicity-, and comorbidity-based subgroups). More research is needed to evaluate CV risk assessment in specific subgroups and its effect on critical outcomes such as CV mortality. Recommendation 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) Discussion The frequency that providers obtain lipid profiles in their patients varies widely. A systematic review by Perera et al. (2015) found little within-patient change in annual lipid measurements.[22] Test-to-test variations often do not represent a real change in risk. Studies assessing individual cholesterol levels found variation as high as 18% in three successive TC measurements.[21] Frequent testing of lipid profiles may lead to over-diagnosis and an increased number of patients who receive unnecessary treatment. 