In November 2013, the American College of Cardiology and American Heart Association (ACC/AHA) released a clinical practice guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease (ASCVD) risk in adults. The guideline recommendations were developed from a rigorous systematic review of randomized, controlled trials (RCTs) and meta-analyses of RCTs that evaluated ASCVD outcomes. Major recommendations address a healthy lifestyle, identification of groups of patients most likely to experience a net benefit form statin therapy, appropriate intensity of statin therapy to reduce ASCVD, safety, decision-making in primary prevention, monitoring therapy, and appropriate use of nonstatin therapy. Areas of controversy are discussed.