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June 18/25, 2019 Circulation. 2019;139:e1082–e1143. DOI: 10.1161/CIR.0000000000000625 e1132

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markers in individuals ineligible for statin therapy according to the 2013 American College of Cardiology/American Heart Association cholesterol guidelines. Circulation. 2015;132:916–22. S4.4.2-49.	 Yeboah J, Young R, McClelland RL, et al. Utility of nontraditional risk markers in atherosclerotic cardiovascular disease risk assessment. J Am Coll Cardiol. 2016;67:139–47. S4.4.2-50.	 Budoff MJ, McClelland RL, Nasir K, et al. Cardiovascular events with absent or minimal coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA) Am Heart J. 2009;158:554–61. S4.4.2-51.	 Schulman-Marcus J, Valenti V, Hartaigh BO, et al. Prognostic utility of coronary artery calcium scoring in active smokers: a 15-year follow-up study. Int J Cardiol. 2014;177:581–3. S4.4.2–52.	Valenti V, Hartaigh BO, Cho I, et al. Absence of coronary artery calcium identifies asymptomatic diabetic individuals at low near-term but not long-term risk of mortality: a 15-year follow-up study of 9715 patients. Circ Cardiovasc Imaging 2016;9:e003528. S4.4.2–53.	Patel J, Al Rifai M, Blaha MJ, et al. Coronary artery calcium improves risk assessment in adults with a family history of premature coronary heart disease: results from Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging. 2015:8;e003186. S4.4.2-54.	 Sharp Collaborative Group null. Study of Heart and Renal Protection (SHARP): randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9 438 patients with chronic kidney disease. Am Heart J. 2010;160:785–94; e10. S4.4.2-55.	 The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA. 1984;251:351–64. S4.4.2-56.	 Spence JD, Huff MW, Heidenheim P, et al. Combination therapy with colestipol and psyllium mucilloid in patients with hyperlipidemia. Ann Intern Med. 1995;123:493–9. S4.4.2-57.	 Pandya A, Sy S, Cho S, et al. Cost-effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease. JAMA. 2015;314:142–50. S4.4.2-58.	 Singh A, Collins BL, Gupta A, et al. Cardiovascular risk and statin eligibility of young adults after an MI: Partners YOUNG-MI Registry. J Am Coll Cardiol. 2018;71:292–302. S4.4.2-59.	 Navar-Boggan AM, Peterson ED, D’Agostino RB Sr, et al. Using age- and sex-specific risk thresholds to guide statin therapy: one size may not fit all. J Am Coll Cardiol. 2015;65:1633–9. S4.4.2-60.	 The Lipid Research Clinics Coronary Primary Prevention Trial results.

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4.4.3 Monitoring in Response to LDL-C–Lowering Therapy

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cardiovascular disease: a systematic review and meta-analysis of controlled trials. Prog Cardiovasc Dis. 2018;61:43–53.

4.4.4 Primary Prevention in Other Age Groups

4.4.4.1 Older Adults

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statin therapy in the elderly: new meta-analyses from the contemporary JUPITER and HOPE-3 randomized trials. Circulation. 2017;135:1979–81. S4.4.4.1-4.	 Yusuf S, Bosch J, Dagenais G, et al. Cholesterol lowering in

intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374:2021–31. S4.4.4.1-5.	 Orkaby AR, Gaziano JM, Djousse L, et al. Statins for primary prevention of cardiovascular events and mortality in older men. J Am Geriatr Soc. 2017;65:2362–8. S4.4.4.1-6.	 Mihaylova B, Emberson J, Blackwell L, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380:581–90. S4.4.4.1-7.	 Savarese G, Gotto AM Jr, Paolillo S, et al. Benefits of statins in elderly subjects without established cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2013;62:2090–9. S4.4.4.1-8.	 Teng M, Lin L, Zhao YJ, et al. Statins for primary prevention of cardiovascular disease in elderly patients: systematic review and meta-analysis. Drugs Aging. 2015;32:649–61. S4.4.4.1-9.	 Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, lifelimiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175:691–700. S4.4.4.1-10.	 Mahabadi AA, Mohlenkamp S, Lehmann N, et al. CAC score improves coronary and CV risk assessment above statin indication by ESC and AHA/ACC primary prevention guidelines. J Am Coll Cardiol Img. 2017;10:143–53. S4.4.4.1-11.	 Mortensen MB, Fuster V, Muntendam P, et al. A simple diseaseguided approach to personalize ACC/AHA-recommended statin allocation in elderly people: the BioImage study. J Am Coll Cardiol. 2016;68:881–91. S4.4.4.1-12.	 Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360:1623–30. S4.4.4.1-13.	 Mortensen MB, Falk E. Primary prevention with statins in the elderly. J Am Coll Cardiol. 2018;71:85–94. S4.4.4.1-14.	 Bell SP, Orr NM, Dodson JA, et al. What to expect from the evolving field of geriatric cardiology. J Am Coll Cardiol. 2015;66:1286–99. S4.4.4.1-15.	 Fleg JL, Forman DE, Berra K, et al. Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association. Circulation. 2013;128:2422–46. S4.4.4.1-16.	 Garfinkel D, Ilhan B, Bahat G. Routine deprescribing of chronic medications to combat polypharmacy. Ther Adv Drug Saf. 2015;6:212–33. S4.4.4.1-17.	 Qi K, Reeve E, Hilmer SN, et al. Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. Int J Clin Pharm. 2015;37:949–57. S4.4.4.1-18.	 Rossello X, Pocock SJ, Julian DG. Long-term use of cardiovascular drugs: challenges for research and for patient care. J Am Coll Cardiol. 2015;66:1273–85. S4.4.4.1-19.	 Han BH, Sutin D, Williamson JD, et al. Effect of statin treatment vs usual care on primary cardiovascular prevention among older adults: the ALLHAT-LLT randomized clinical trial. JAMA Intern Med. 2017;177:955–65. S4.4.4.1-20.	 Odden MC, Pletcher MJ, Coxson PG, et al. Cost-effectiveness and

population impact of statins for primary prevention in adults aged 75 years or older in the United States. Ann Intern Med. 2015;162:533–41.

4.4.4.2 Young Adults (20 to 39 Years of Age)

S4.4.4.2-1.	 Strong JP, Malcom GT, Oalmann MC, et al. The PDAY Study: natural history, risk factors, and pathobiology. Pathobiological Determinants of Atherosclerosis in Youth. Ann N Y Acad Sci. 1997;811:226–35.; discussion 35–7. S4.4.4.2-2.	 McGill HC Jr, McMahan CA, Herderick EE, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 2000;20:836–45. S4.4.4.2-3.	 Williams RR, Hopkins PN, Hunt SC, et al. Population-based frequency of dyslipidemia syndromes in coronary-prone families in Utah. Arch Intern Med. 1990;150:582–8. S4.4.4.2-4.	 McGill HC Jr, McMahan CA, Malcom GT, et al. Effects of

serum lipoproteins and smoking on atherosclerosis in young men and women. The PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 1997;17:95–106.

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