Lipid profiles help estimate patient’s short and long-term atherosclerotic cardiovascular disease risk over the life course and inform treatment decisions. Advanced lipid testing can provide additional information in selected patients. New 2018 cholesterol guidelines suggest which patients may benefit from additional testing. In patients 40–75years, calculation of a 10-year atherosclerotic cardiovascular disease risk score begins the clinician-patient risk discussion. In those at intermediate risk (10-year risk 7.5–19.9%) for future events, inclusion of enhancing factors personalizes the risk decision.