Purpose of Review: This paper proposes several strategies for health systems, primary care clinicians, cardiologists, and other members of the healthcare team to better engage individuals in decisions around primary preventive statin therapy. Recent Findings: The 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines for cholesterol management provide an opportunity to better engage patients in decisions about primary prevention of cardiovascular disease, including the initiation of statin therapy. Summary: In the shared decision making process, clinicians and patients work together to determine what is best for the patient, taking into account the scientific evidence informing guideline recommendations, the clinician’s knowledge and experience, the known burdens of taking a daily lifelong medication, and the patient’s preferences, values and goals. Several challenges exist to adopting shared decision making as a patient-centered model of care.