[109-113] The Work Group s confidence in the quality of the evidence was very low. While the evidence does not support setting an LDL-C target or goal for reducing CV events with statins, there is evidence showing that more intense LDL-lowering treatment reduces CV events in secondary prevention patients at higher risk. However, this may be achieved by using a statin dose target rather than an LDL target or by PCSK9 inhibitors. Patient values and preferences likely vary somewhat because patients may expect a cholesterol test and want to know their cholesterol levels. Finally, frequent lipid monitoring has an associated cost (i.e., resources for testing and patient and provider time). Thus, the Work Group decided upon a Weak against recommendation. A direct study evaluating the comparative effectiveness and safety of treating to reach specific LDL-C or non-HDL-C goals versus the use of a fixed-dose statin and based on initial CV risk assessment is needed. Recommendation 23. For patients who cannot tolerate a statin, we suggest a washout period followed by a re- challenge with the same or a different statin or lower dose, and if that fails, a trial of intermittent (nondaily) dosing. (Weak for | Reviewed, New-added) Discussion Retrospective studies have demonstrated that statins can usually be continued after documentation of a statin-related adverse event and that mortality is improved by continuing the treatment. A retrospective cohort study by Zhang et al. (2013) examined adherence to statins at one year following statin-related events.[114] Over 6,000 patients who discontinued statins were re-challenged, and over 90% were ultimately able to tolerate a statin. More than 40% were re-challenged with the same statin to which the adverse event was documented. 