The present chapter outlines on the statin guidelines: controversies to consensus by mentioning the questions of the American College of Cardiology (ACC) and American Heart Association (AHA) but only 3 were to ultimately addressed. Atherosclerosis Society (EAS) guidelines consider all the available evidences. The governing bodies sets the guidelines which marks the important points with whom to treat and have categorized four major patient groups who would benefit from lipid modification therapy include individuals with established cardiovascular disease (CVD), diabetes mellitus, and familial hypercholesterolemia. Similarly The ACC/AHA guidelines essentially recommend regimens which reduce LDL-C by 50% atorvastatin 40 mg, 80 mg and rosuvastatin 20 mg are endorsed as RCT outcomes tested high-intensity statins, rosuvastatin 40 mg is not, even though it is Food and Drug Administration (FDA) approved. The chapter concludes based on the concept that one needs to individualize each patient based on clinical judgment and experience. Initiation of therapy should be done considering an individual’s clinical as well as laboratory parameters including lipid levels.