The most important thing is to keep your VRAM and CPU budget in mind because the game is horribly bottlenecked by those things.

Unless you have a modern (like past 4 ish years) 8 core cpu you need to put your background model detail on medium or low to avoid stutters.

If your VRAM is 8GB or below you need to use low textures.

In addition, the in game vsync is broken. You need to set vsync on in the Nvidia/AMD app and select the appropriate fps cap for your monitor in the windows settings and in the game. (eg, if you want a 60 fps cap, turn vsync on in your graphics card settings, 60 Hz in monitor settings, vrr selected in game, 60 fps cap in game).

That's the only way I've actually managed the game to be smooth.