However, we are less concerned about the calculator (which can be modified to improve performance) than we are about the lowering of risk thresholds for primary prevention. Given the uncertainty of any calculator in accurately predicting 10-year risk, we believe that the decision to recommend pharmacotherapy for primary prevention should be based on a risk of 10% or 15% (the latter being the 10-year event rate in the AFCAPS placebo group). The expert panel based its recommendation on a risk–benefit analysis, which underestimates the adverse events of statins. If rare adverse events, such as rhabdomyolysis, are focused on, common adverse events that lead to treatment discontinuation (such as muscle pain) are undervalued. Once a decision is made to treat lower-risk patients, we are concerned that those who cannot tolerate a statin might then be transitioned to nonstatin medications, such as ezetimibe, which have not been shown to improve any clinical outcomes.