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The American College of Cardiology American Heart Association (ACC/AHA) cholesterol guidelines replaced the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) in 2013,1 a change that was accompanied by significant controversy.2 Notable among the criticisms was that the pooled cohort equations (PCE) overestimates risk and coupled with the relatively lenient risk threshold (10-year PCE ≥7.5%), would unnecessarily increase statin eligibility in the USA. The risk-benefit ratio and cost-effectiveness of this new approach, specifically for primary prevention, was questioned since statins (in addition to preventing cardiovascular disease (CVD) events) have known significant side effects. Pandya and colleagues examine the cost-effectiveness of 10-year risk thresholds for initiation of …