Nothing here is a black box. Below is every branch point the tool runs, for every topic, including where an extra test would change the decision, and where the tool deliberately stops short of recommending something.
This is educational software. It turns the numbers you enter into the same screening, counselling and prevention guidance that established authorities (the AHA, ACC, KDIGO, and the specific trials named on every recommendation) already publish for people with those numbers, and it shows the source behind each one.
It does not diagnose disease, read imaging or biopsy results, or prescribe or dispense medication. Where a recommendation would need to name a specific drug or dose and your answers don't hold what that decision depends on, it's shown as a question for your clinician instead of an instruction. See “Questions when the context is missing” below.
Each rule behind your plan has its own page: the question, the exact words it produces, the guideline behind it, and whether a clinician has signed it off. Generated from the running engine, so it can't drift from what the app does.
A recommendation that names a specific drug declares what it depends on: kidney function, potassium, valve status, bleeding history, other medications. If your intake can't answer those, it is shown as a question for your clinician instead, with the missing pieces named. Some gaps close when you answer more intake questions; some (like a full medication list) never do, and say so.
How strongly something is recommended and what kind of evidence sits behind it are shown separately, so a trial result can be told apart from expert consensus or our own inference.
Major factors (very high Lp(a), premature family history, South Asian ancestry, LDL 160–189, ApoB ≥120) can tip a decision on their own, keep a statin on the table after a calcium score of zero, and justify a calcium scan even at low calculated risk. Standard factors tip a borderline decision. Provisional ones, such as a single hs-CRP reading, don't count until confirmed.
These are not things to look up. They are things to act on.
Chest pressure, tightness, or heaviness, especially spreading to the jaw, neck, or an arm, or coming with sweating, nausea, or breathlessness
Call emergency services now, before anything else and before taking anything. Do not drive yourself and do not wait to see whether it passes. Then, while you are waiting: if you are fully alert, not allergic to aspirin, and have not been told to avoid it, chew 162 to 325 mg of plain aspirin (not the enteric-coated kind, which is absorbed too slowly). Never delay the call in order to find the aspirin.
Sudden face droop, arm weakness, or trouble speaking, even if it resolves within minutes
Call emergency services now. A symptom that resolves is still a warning that a stroke may follow, and the treatment window is measured in hours.
Fainting, or nearly fainting, during exertion
Emergency assessment. Fainting on exertion is a different and more serious thing than fainting while standing up.
A leg or foot that suddenly turns cold, pale, or numb, or becomes severely painful, especially with peripheral artery disease
Call emergency services now. This is a blocked artery in the limb, not just a cramp, and tissue starts dying within hours without treatment to restore blood flow.
Chest discomfort that reliably comes on with exertion and goes away with rest, over days or weeks
This is the classic pattern of a narrowed artery, and it needs an appointment within days, not months. It stays a non-emergency only while it stays predictable, and becomes one if it starts happening at rest or at lower and lower effort.
New breathlessness lying flat, waking up short of breath, or new swelling in the legs
Contact your doctor within days. These are fluid symptoms rather than artery symptoms.
A racing, fluttering, or irregular heartbeat that lasts more than a few minutes
Worth an appointment, and worth recording if you have a smartwatch or a portable ECG. A captured rhythm is worth far more than a description of one.
A foot or leg wound that isn't healing, or pain in a foot or calf at rest, with known peripheral artery disease
Contact your doctor within days, not weeks. Both are signs the blockage may be advanced enough to threaten the limb, and this is treated as more urgent than exercise-only claudication.
Inputs are grouped as Labs, Imaging, Echo and Genetics so the gaps are visible. Risk is calculated with the AHA PREVENT equations: 10-year PREVENT-ASCVD for cholesterol decisions, 10-year PREVENT-CVD for the blood-pressure threshold, and 30-year risk for adults 30–59.
The equations rank people reasonably well (right about 73 times in 100 when comparing someone who has an event with someone who doesn't) and are well calibrated in contemporary populations, but they cannot see Lp(a), family history, or South Asian ancestry, and in South Asian adults they under-estimate risk substantially. Your results say which of those caveats apply to your number.
The decision runs in order. Established cardiovascular disease and an LDL of 190 or more come first. Then three diagnoses make a statin indicated between 40 and 75 on their own, whatever the risk score says: diabetes, chronic kidney disease stage 3–4, and HIV. Only after that does the 10-year risk band decide. Below 3%, adults 30–59 with a 30-year risk of 10% or more, or LDL 160–189, still get the conversation.
The LDL target comes from the risk category, not from any single factor. Elevated Lp(a) argues for treating harder but does not set its own number.
| Situation | LDL goal | Non-HDL goal |
|---|---|---|
| Borderline (3–<5%) or intermediate (5–<10%) risk | <100 mg/dL | <130 mg/dL |
| High risk (≥10%), or calcium score ≥100 | <70 mg/dL | <100 mg/dL |
| Established cardiovascular disease | <70 mg/dL | <100 mg/dL |
| Established disease at very high risk | <55 mg/dL | <85 mg/dL |
A CAC scan is a CT scan of your heart (no contrast dye, no needles) that counts hardened, calcified plaque built up inside your coronary arteries. More calcium generally means more total plaque accumulated over your lifetime — it's a snapshot of buildup, not a live picture of blood flow.
Healthy artery
Calcified (hard) plaque
✓ Shows up on a CAC scanSoft (non-calcified) plaque
✗ Invisible to a CAC scanWhat it shows
What it doesn't show
The gap between calcified and real
PESA, a Spanish study that scanned 4,002 people aged 40 to 54 with no heart disease using both a calcium score and an ultrasound of their other arteries, found atherosclerosis somewhere in 63% of them. Only 18% had any coronary calcium at all. Most early plaque in this age range has not calcified yet, so a calcium score is measuring a later stage of a process that, for most people who have it, has already started.
Score, roughly translated
What the score changes about treatment
Why a repeat scan can mislead
Statins make plaque denser while making it more stable, and the score weights density — so a score that rises on treatment is expected, not a sign the statin failed. Serial calcium scores are not a reliable way to judge whether treatment is working, and no guideline endorses a rescan interval for that purpose.
If your doctor needs to know exactly where a blockage is and how severe it is, that's a different test — usually a CT coronary angiogram (uses contrast dye, shows soft plaque and narrowing) or, for urgent situations, an invasive angiogram done during a procedure.
Known ASCVD (prior heart attack, stroke, or revascularization)?
Very high risk? (multiple major events, or one plus several high-risk conditions)
Your situation (severe hypercholesterolemia short-circuits the risk score)
Yes
High-intensity statin; LDL-C <55, non-HDL-C <85; colchicine raised as a question
How this rule worksNo
High-intensity statin; LDL-C <70, non-HDL-C <100; colchicine raised as a question
How this rule worksLDL-C ≥190 mg/dL
High-intensity statin now, regardless of calculated risk (severe hypercholesterolemia)
How this rule worksCKD stage 3–4, age 40–75
Moderate-intensity statin (± ezetimibe) on the diagnosis alone; LDL-C <100
How this rule worksHIV, age 40–75
Statin on the diagnosis alone; LDL-C <100; check interactions with antiretrovirals
How this rule worksDiabetes, age 40–75
Statin recommended on the diagnosis alone; risk score sets the intensity
How this rule works10-yr PREVENT-ASCVD 5–<10% (intermediate)
Statin should be started; LDL-C <100, non-HDL-C <130 (30–49% reduction)
How this rule works10-yr risk 3–5% (borderline)
How this rule works10-yr risk <3%
How this rule worksCoronary artery calcium (CAC) score? (further testing beyond basic labs)
Coronary artery calcium (CAC) score? (further testing beyond basic labs)
Coronary artery calcium (CAC) score? (further testing beyond basic labs)
A risk-enhancing factor that counts? (weighted — a single unconfirmed hs-CRP does not count until repeated)
Coronary artery calcium (CAC) score? (further testing beyond basic labs)
hs-CRP ≥2 mg/L, confirmed on a repeat test? (further testing beyond basic labs)
Age 30–59 with high lifetime risk, or a major risk enhancer (e.g. premature family history, South Asian ancestry) or elevated Lp(a)?
0, and no risk-enhancing factors
Reasonable to defer statin; reassess CAC in 3–7 years
How this rule works0, but risk-enhancing factors present
Statin still on the table — a CAC scan can't see Lp(a)
How this rule worksAbove 0
Treat now; the score sets the goal — any calcium → LDL <100, ≥100 → <70, ≥300 → <55 optional
How this rule worksNot measured
Offered when the decision is still open (borderline or intermediate risk, men ≥40 / women ≥45, or below 3% with a major enhancer)
How this rule works0, and no risk-enhancing factors
Reasonable to defer statin; reassess CAC in 3–7 years
How this rule works0, but risk-enhancing factors present
Statin still on the table — a CAC scan can't see Lp(a)
How this rule worksAbove 0
Treat now; the score sets the goal — any calcium → LDL <100, ≥100 → <70, ≥300 → <55 optional
How this rule worksNot measured
Offered when the decision is still open (borderline or intermediate risk, men ≥40 / women ≥45, or below 3% with a major enhancer)
How this rule works0, and no risk-enhancing factors
Reasonable to defer statin; reassess CAC in 3–7 years
How this rule works0, but risk-enhancing factors present
Statin still on the table — a CAC scan can't see Lp(a)
How this rule worksAbove 0
Treat now; the score sets the goal — any calcium → LDL <100, ≥100 → <70, ≥300 → <55 optional
How this rule worksNot measured
Offered when the decision is still open (borderline or intermediate risk, men ≥40 / women ≥45, or below 3% with a major enhancer)
How this rule worksOne or more present
Statin reasonable to start now — no further testing needed to decide
How this rule works0, and no risk-enhancing factors
Reasonable to defer statin; reassess CAC in 3–7 years
How this rule works0, but risk-enhancing factors present
Statin still on the table — a CAC scan can't see Lp(a)
How this rule worksAbove 0
Treat now; the score sets the goal — any calcium → LDL <100, ≥100 → <70, ≥300 → <55 optional
How this rule worksNot measured
Offered when the decision is still open (borderline or intermediate risk, men ≥40 / women ≥45, or below 3% with a major enhancer)
How this rule worksNot measured
Order hs-CRP — a low-cost blood test that can independently support the decision
How this rule works30-yr risk ≥10%, or LDL-C 160–189, at age 30–59
Moderate-intensity statin reasonable; LDL-C <100
How this rule worksCoronary artery calcium (CAC) score? (further testing beyond basic labs)
Coronary artery calcium (CAC) score? (further testing beyond basic labs)
0, and no risk-enhancing factors
Reasonable to defer statin; reassess CAC in 3–7 years
How this rule works0, but risk-enhancing factors present
Statin still on the table — a CAC scan can't see Lp(a)
How this rule worksAbove 0
Treat now; the score sets the goal — any calcium → LDL <100, ≥100 → <70, ≥300 → <55 optional
How this rule worksNot measured
Offered when the decision is still open (borderline or intermediate risk, men ≥40 / women ≥45, or below 3% with a major enhancer)
How this rule works0, and no risk-enhancing factors
Reasonable to defer statin; reassess CAC in 3–7 years
How this rule works0, but risk-enhancing factors present
Statin still on the table — a CAC scan can't see Lp(a)
How this rule worksAbove 0
Treat now; the score sets the goal — any calcium → LDL <100, ≥100 → <70, ≥300 → <55 optional
How this rule worksNot measured
Offered when the decision is still open (borderline or intermediate risk, men ≥40 / women ≥45, or below 3% with a major enhancer)
How this rule worksThe target is below 130/80 for essentially everyone. Whether medication starts at 130/80 or 140/90 depends on being in the higher-risk group: diabetes (including by A1c alone), known cardiovascular disease, kidney disease (a low eGFR or protein in the urine), or a 10-year PREVENT-CVD risk of 7.5% or more. Below the medication threshold, lifestyle comes first, but only for three to six months. If blood pressure is still 130/80 or higher after that, medication is recommended.
Below 130/80 mmHg?
Diabetes (incl. by A1c), known CVD, CKD (low eGFR or albuminuria), or 10-yr PREVENT-CVD ≥7.5%?
Yes — lower threshold applies (130/80)
How this rule worksNo — standard threshold applies (140/90)
How this rule worksAt or above 130/80? (In this group the treatment threshold is the goal, so being above goal means yes.)
At or above 140/90?
Everything turns on the ejection fraction. At 40% or below, four drug classes each help people live longer; at 50% and above the regimen is different. "Not known" is its own branch rather than a default. Because which of the four classes suit someone depends on potassium, kidney function, blood pressure and what has already been tried, that recommendation is shown as a question for a cardiologist unless the intake can support it.
Diagnosed heart failure?
Ejection fraction — the number that decides the whole regimen
Care that applies at any ejection fraction
40% or below (reduced)
All four classes: ARNI (or ACEi/ARB), heart-failure beta blocker, MRA, SGLT2 inhibitor; defibrillator question at ≤35%
How this rule works50% or above (preserved)
SGLT2 inhibitor, an MRA, and treat the drivers — blood pressure, atrial fibrillation, sleep apnea, weight
How this rule worksNot known
Get the number from an echocardiogram — nothing above can be chosen without it
How this rule worksAlways
Daily weights with a call threshold; avoid NSAIDs; cardiac rehab; check iron; stay vaccinated
How this rule worksTwo forks decide the anticoagulation question. First, how the AF was found. A clinical diagnosis and a wearable's high-rate episode don't share an evidence base. Second, the CHA2DS2-VASc score: about 2% annual stroke risk (≥2 in men, ≥3 in women) is the threshold. Aspirin is explicitly not an alternative. Which blood thinner is named only once valve status, kidney function, weight and bleeding history are on file; otherwise it is a question.
Atrial fibrillation?
How was it found? (the evidence differs)
CHA2DS2-VASc — untreated stroke risk above ~2% a year?
Applies whatever the score
Device- or wearable-detected only
Confirm on an ECG first; anticoagulation is a narrower call (NOAH-AFNET 6 / ARTESiA)
How this rule worksYes (score >=2 men / >=3 women)
Anticoagulation recommended; a DOAC preferred over warfarin
How this rule worksAlways
Weight loss, alcohol reduction, sleep apnea treatment, blood pressure control
How this rule worksThe evidence splits three ways. With established cardiovascular disease, semaglutide has proven event reduction (SELECT). With type 2 diabetes, the class has outcome data. For obesity alone, these drugs are effective for weight but cardiovascular benefit has not yet been shown in a trial. Newer agents that lose more weight have no outcome data at all. Everyone eligible is told that most of the weight returns after stopping and that muscle loss needs active defending.
BMI ≥27 kg/m², or type 2 diabetes?
How strong is the cardiovascular evidence for someone like you?
Applies to anyone starting one
Established cardiovascular disease
SELECT: 8.0% → 6.5% major events; semaglutide approved for CV risk reduction
How this rule worksType 2 diabetes
Outcome benefit across the class; SURPASS-CVOT tested tirzepatide against an active comparator
How this rule worksNeither — obesity alone
Approved for weight; cardiovascular benefit not yet proven in this group
How this rule worksAlways
Weight returns on stopping (two-thirds within a year); 25–40% of loss is muscle; GI effects near-universal
How this rule worksMeasured once in a lifetime. Elevated Lp(a) counts as a risk enhancer (very high Lp(a) counts heavily) and favours starting or intensifying LDL-lowering, but it does not set a separate LDL target. There is still no approved drug that lowers it, and the first large outcomes trial of one missed its primary endpoint in September 2026.
Lp(a) elevated (≥50 mg/dL or ≥125 nmol/L)?
Yes
No approved Lp(a)-lowering drug (first outcomes trial negative, Sept 2026) — counts as a risk enhancer and favours intensifying LDL-lowering
How this rule worksVery high (≥100 mg/dL or ≥250 nmol/L)?
Yes
Treat LDL harder than risk alone suggests; goal still set by risk category; maximal control of other factors
How this rule worksNo — elevated but not extreme
Favours starting or intensifying LDL-lowering; check first-degree relatives' Lp(a)
How this rule worksEveryone is placed at a stage (risk factors only, plaque found without an event, or after an event) because "should I look?" and "how do I monitor what I have?" are different questions. Each test is shown with what it finds, what a normal result can't rule out, and what each possible result would change about treatment. A test that would change nothing isn't recommended however well it predicts risk.
Monitoring intervals are computed from what you're on: lipids 4–12 weeks after any dose change, then every 3–6 months in the first year. Repeat calcium scores and serial plaque imaging are described honestly. The measurements are real, but no trial has shown that steering treatment by them prevents more events, and no guideline endorses a rescan interval.
Lifestyle isn't the low-risk branch. It sits under every recommendation above, including alongside a statin, and it's attached to the specific number it moves (LDL, blood pressure, blood sugar, weight) with an honest effect size. The plan comes from a calorie target (Mifflin-St Jeor resting burn × activity, adjusted for your weight goal), about 1.6 g/kg of protein, and the AHA target of 150 minutes a week plus two strength days. It can be shared with the people you live with, showing meals and workout days only.
Submit an intake and your own food and movement plan appears here.
Seven profiles run through the real engine: inputs, the plan they get, and the guideline recommendations behind it. They recompute whenever the logic changes, and a test fails if the engine stops taking the path each description claims.
42, no family history, normal labs and blood pressure. The point of this one: a low score means lifestyle is the whole plan — not a lesser plan.
What they're told to do first
The guideline recommendations behind it
Lifestyle levers switched on for this profile: bring your ldl down with food.
58, calculated risk lands in the borderline 3–5% band — on its own, a coin flip. But Lp(a) is elevated, which the calculator doesn't capture, so the recommendation firms up to "reasonable to start a statin". A calcium scan stops being about whether to treat and becomes about how far: it would set the LDL target.
Risk-enhancing factors: Elevated lipoprotein(a) — 78 mg/dL
What they're told to do first
The guideline recommendations behind it
Lifestyle levers switched on for this profile: bring your ldl down with food; bring your blood pressure down without a prescription.
54, type 2 diabetes, already taking a statin, triglycerides high. Two things fall out that a risk score alone would miss: diabetes in this age range is a statin indication by itself, and this exact combination is the population where prescription omega-3 has outcome data.
Risk-enhancing factors: Triglycerides 240 mg/dL; Diabetes, age over 40
What they're told to do first
The guideline recommendations behind it
Lifestyle levers switched on for this profile: bring your ldl down with food; bring your blood pressure down without a prescription; take pressure off your blood sugar; lose weight in a way that keeps the muscle.
67, heart failure with an ejection fraction of 32%, eGFR 58, protein in the urine. Two things surface that no cholesterol-first tool would: kidney function alone makes a statin indicated, and the four heart-failure drug classes come up — deliberately as a question to take to a cardiologist rather than a checklist, because potassium and the current medication list aren't on file.
Risk-enhancing factors: Reduced kidney function — eGFR 58; Protein in the urine — UACR 60 mg/g
What they're told to do first
The guideline recommendations behind it
Lifestyle levers switched on for this profile: bring your ldl down with food; bring your blood pressure down without a prescription; day-to-day habits that keep you out of hospital.
46, normal numbers, calculated 10-year and 30-year risk both low. On the score alone, nothing to do. But South Asian ancestry carries roughly twice the event rate the equations predict, so it counts as a major risk enhancer: a statin conversation opens, and a calcium scan is offered even at this risk level — and the risk number itself is flagged as a floor rather than an estimate.
Risk-enhancing factors: South Asian ancestry
What they're told to do first
The guideline recommendations behind it
Lifestyle levers switched on for this profile: bring your ldl down with food; bring your blood pressure down without a prescription.
77, woman, treated blood pressure, A1c in the diabetes range, diagnosed atrial fibrillation. Her stroke-risk score is well over the threshold, so the question of anticoagulation is firmly on. Which drug is not: without valve status and bleeding history on file, the DOAC recommendation arrives as a question — answer those two intake questions and it becomes a direct recommendation.
Risk-enhancing factors: Diabetes, age over 40
What they're told to do first
The guideline recommendations behind it
Lifestyle levers switched on for this profile: bring your ldl down with food; bring your blood pressure down without a prescription; take pressure off your blood sugar; lose weight in a way that keeps the muscle.
63, prior heart attack, no other high-risk conditions on record. No risk score is run: high-intensity statin with an LDL goal below 70 — the standard secondary-prevention tier, not the very-high-risk tier of 55. Colchicine arrives as a question rather than a recommendation, because whether it suits you turns on kidney function and drug interactions the intake doesn't hold.
What they're told to do first
The guideline recommendations behind it
Lifestyle levers switched on for this profile: bring your ldl down with food; bring your blood pressure down without a prescription.
Sources used: 2026 ACC/AHA/Multisociety Dyslipidemia Guideline; 2025 AHA/ACC Hypertension Guideline (PREVENT-CVD gate); 2023 ACC/AHA/ACCP/HRS Atrial Fibrillation Guideline; 2022 AHA/ACC/HFSA Heart Failure Guideline; KDIGO 2024 CKD Guideline; AHA PREVENT equations (Circulation 2024); CTT Collaboration statin meta-analyses; SELECT, SOUL and SURPASS-CVOT incretin outcome trials; LoDoCo2 colchicine trial; Lp(a)HORIZON topline (negative, September 2026)