These guidelines encompass both nonpharmacologic and pharmacologic interventions. Here’s a breakdown of the key recommendations:

1. Physical Activity: The guidelines emphasize the importance of encouraging patients to engage in physical activity. Adherence to a regular exercise routine is considered more crucial than specifying a particular type, duration, or intensity of exercise.
2. Mediterranean Diet: The Mediterranean diet is strongly recommended to reduce the risk of cardiovascular disease, highlighting the significant role of dietary choices in heart health.
3. Primary Prevention with Statins: Healthcare professionals are advised to discuss the initiation of statins, preferably high-intensity statins, with patients who have a 10-year cardiovascular disease risk of 20% or higher for primary prevention.
4. Primary Prevention with Statins (Moderate-Intensity): For patients with a 10-year cardiovascular disease risk falling in the 10%-19% range, clinicians are suggested to consider the initiation of statins, preferably of moderate intensity, for primary prevention.
5. Lipid Level Re-testing: It is recommended to re-test lipid levels no earlier than five years and preferably in ten years for patients with a 10-year cardiovascular disease risk of less than 10% when estimating risk for primary prevention.
6. Non-Statin Lipid-Lowering Drugs: The guidelines advise against the use of non-statin lipid-lowering medications either as monotherapy or in combination with statins for primary prevention.
7. Secondary Prevention with High-Intensity Statins: For secondary prevention, healthcare providers are recommended to encourage the initiation of high-intensity statin therapy while discussing the potential risks and benefits with patients.
8. Additional Risk Reduction: In cases where additional cardiovascular risk reduction is desired beyond maximizing statin therapy for secondary prevention, healthcare professionals are advised to discuss the potential use of ezetimibe or PCSK9 inhibitors with the patient.
9. Icosapent Consideration: The guidelines suggest considering the addition of Icosapent to statins only after considering the potential adverse effects, such as atrial fibrillation and bleeding, following a discussion about the use of ezetimibe or PCSK9 inhibitors.

These updated guidelines provide a comprehensive framework for managing lipid levels and reducing the risk of cardiovascular disease, with a focus on tailoring interventions to individual patient risk profiles.

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