What is the recommended primary prevention for patients who are unable to tolerate statins?
For primary prevention in patients who are unable to tolerate statins, we suggest reinforcing adherence to positive lifestyle changes. For patients who prefer to try pharmacotherapy, we suggest considering treatment with gemfibrozil or bile acid sequestrants (BAS), noting that these agents have been associated with only a small CVD risk reduction and studied in limited populations, e.g., males with low density lipoprotein cholesterol (LDL C) >190 mg/dL.