Since the publication of the 2012 guidelines new literature has emerged to inform decision making. The 2016 guidelines primary panel selected a number of clinically relevant questions and has produced updated recommendations, based on important new findings. In subjects with clinical atherosclerosis, abdominal aortic aneurysm, most subjects with diabetes or chronic kidney disease and those with low-density lipoprotein (LDL) cholesterol ≥ 5 mmol/L, statin therapy is recommended. For all others, there is an emphasis on risk assessment linked to lipid determination to optimize decision making. We have recommended non-fasting lipid determination as a suitable alternative to fasting levels. Risk assessment and lipid determination should be considered in individuals over 40 years of age or in those at increased risk regardless of age. Pharmacotherapy is generally not indicated for those at low Framingham Risk Score (FRS) <10%. A wider range of patients are now eligible for statin therapy in the intermediate risk category (10-19%) and in those at high FRS (>20%). Despite the controversy, we continue to advocate for LDL-C targets for subjects who are started on therapy. Detailed recommendations are also presented for health behavior modification which is indicated in all subjects. Finally, recommendation for the use of non-statin medications is provided. Shared decision making is vital as there are many areas where clinical trials do not fully inform practice. The guidelines are meant to be a platform for meaningful conversation between patient and care provider so that individual decisions can be made for risk screening, assessment and treatment.