Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States. Choosing the appropriate patients for whom to initiate statin therapy to reduce the risk of ASCVD is of paramount importance. The new AHA/ACC guidelines on the treatment of cholesterol emphasize a patient-centered approach that shifts away from arbitrary LDL-C goals and recommends targeting statin therapy in patient populations that show ASCVD risk-reduction benefit. In addition, the guidelines emphasize lifestyle modification and the importance of the clinician-patient relationship in discussing ASCVD risk and initiating statin therapy.