Thus, the use of PUFA is reasonable in patients with HFrEF regardless of type and lipid profile. Recommendations Harmonized With Existing Guidelines for the Treatment of Hyperlipidemia in Patients at Risk for and With Established HF See Tables 10 and 11 for a summary of these recom- mendations. Stage A HF 1. Lipid disorders should be controlled in accor- dance with contemporary guidelines5,52,272,286 (Class IIa; Level of Evidence B). Stage B HF 1. In patients with a recent or remote history of MI or acute coronary syndrome, statins should be used to prevent cardiovascular (Class I; Level of Evidence A). Stages C and D HF 1. PUFA supplementation is reasonable to use as adjunctive therapy in patients with NYHA class II to IV symptoms and HFrEF or HFpEF, unless contraindicated, to reduce mortality and cardiovascular hospitalizations8,277 279 (Class IIa; Level of Evidence B). 2. Statins are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications, and routine use of statins for the treatment of HF is not indicated outside of current practice guide- lines for the primary and secondary preven- tion of atherosclerotic vascular disease5,8,273 276 (Class III: No benefit; Level of Evidence A). Metabolic Syndrome and HF: Clustering Risk With Comorbidities The Metabolic Syndrome and Incremental Risk in HF In the earlier sections of this document, the indepen- dent roles of hypertension, diabetes mellitus, and obe- sity in the development of HF and their effect on out- comes in patients with HF are reviewed. In this section, we review whether there is incremental risk when these comorbidities cluster as the metabolic syndrome in patients with HF. 