Question special

I want to thank the authors and experts for the thoughtful and enlightening discussion so far. It appears that based on the collected evidence and FOURIER, a main goal for treating patients at high risk for ASCVD is to lower LDL-C by some combination of statins, ezetimibe, and PCSK9 inhibitors. For the practicing internists who have the rare statin intolerant patients that failed multiple trials of different statins, can they be reassured that monotherapy with a PCSK9 inhibitor that lowers LDL-C to a goal range is sufficient? Should they still try to get their patients on a minimally tolerated dose of statin, such as with an alternating day regimen? For primary prevention patients, is evolocumab a substitute for a "high" intensity statin under current guidelines? Of course, cost and insurance coverage factor in the equation, so let's consider this mainly from an outcomes perspective.