Recommendation
We recommend management that includes statin therapy in high risk conditions including clinical atherosclerosis, abdominal aortic aneurysm, most diabetes mellitus, chronic kidney disease (age > 50 years) and those with LDL-C ≥ 5.0 mmol/L to lower the risk of CVD events and mortality (Strong Recommendation, High Quality Evidence).

Recommendation: a. We recommend management that does not include statin therapy for individuals at low risk (modified FRS < 10 %) to lower the risk of CVD events (Strong Recommendation, High Quality Evidence).

1. a. We recommend management that does not include statin therapy for individuals at low risk (modified FRS < 10 %) to lower the risk of CVD events (Strong Recommendation, High Quality Evidence).
2. We recommend management that includes statin therapy for individuals at high risk (modified FRS ≥ 20%) to lower the risk of CVD events (Strong Recommendation, High Quality Evidence).
3. We recommend management that includes statin therapy for individuals at intermediate risk (modified FRS 10-19%) with LDL-C ≥ 3.5 mmol/L to lower the risk of CVD events. Statin therapy should also be considered for intermediate risk persons with LDL-C <3.5 mmol/L but with apo B ≥ 1.2 g/L or non-HDL-C ≥ 4.3 mmol/L or in men ≥ 50 and women ≥ 60 years of age with ≥ 1 CV risk factor (Strong Recommendation, High Quality Evidence).

Values and Preferences: This recommendation applies to individuals with an LDL-C ≥ 1.8 mmol/L. Any decision regarding pharmacological therapy for CV risk reduction in IR persons needs to include a thorough discussion of risks, benefits, and cost of treatment, alternative nonpharmacological methods for CV risk reduction and each individual’s preference. The proportional risk reduction associated with statin therapy in RCTs in (IR) persons is of similar magnitude to that attained in high-risk persons. Moreover, irreversible severe side effects are very rare and availability of generic statins results in low cost of therapy. However, the absolute risk reduction is lower. Statin therapy may be considered in persons with FRS of 5%-9% with LDL-C ≥ 3.5 mmol/L or other CV risk factors as the proportional benefit from statin therapy will be similar in this group as well.