When I was asked to write this Perspective on the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines,1 I wondered why any reasonable person would agree to do so? It is nice to have your thoughts and opinions in a prestigious journal read by your closest peers, but could it be anything more than a lose-lose situation? I decided, therefore, to preface the perspective with several disclosures. First, I was a member of the original Adult Treatment Panel (ATP) guidelines committee—on the Drug Treatment Subcommittee.2 I was never again asked to be on the committee, but that rejection has had no effect on what I have written here. Second, I think that physician–scientists have the responsibility to integrate all available data, with appropriate priorities, and draw conclusions that can be offered to patients, clinicians, and the world-at-large. So let me state that, based on what I have integrated from a variety of sources for the past 40 years, I have concluded that lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk for atherosclerotic cardiovascular disease (ASCVD), and that the level of LDL-C is important—lower is better. Third, as someone who led a major clinical trial—Action to Control Cardiovascular Risk in Diabetes Lipid3—I know that although randomized clinical trials (RCTs) provide the best evidence for the efficacy and safety of an intervention, each and every RCT has deficiencies. We must avoid, therefore, the tyranny of RCT evidence-based dogma. Fourth, at the end of this piece is my official Disclosure, a listing of my pharmaceutical company relationships. Suffice it to say that all of us who have such relationships must carefully look in the mirror when we evaluate guidelines. However, the same is true for our colleagues who avoid, as part of their career paths, all such …