Recommendation 1: We recommend that a cardiovascular risk assessment be completed every 5 years for men and women age 40 to 75 using the modified Framingham risk score or Cardiovascular Life Expectancy Model to guide therapy to reduce major cardiovascular events. A risk assessment may also be completed whenever a patient’s expected risk status changes (Strong Recommendation, High Quality Evidence).

Recommendation 2: We recommend sharing the results of the risk assessment with the patient to support shared decision making and improve the likelihood that patients will reach lipid targets (Strong Recommendation, High Quality Evidence).

Practical Tip: While there is good evidence to support the use of statins in secondary prevention in patients over the age of 75 years for some outcomes, a mortality benefit has not been demonstrated.In addition, the evidence for statin use in primary prevention is lacking in this population, mainly because they have not been extensively studied. For robust elderly patients felt to be at higher risk a discussion about the importance of statin therapy in overall management should be undertaken as these patients are often at high risk where a CVD event has importance consequences for morbidity.