Very high risk? (multiple major events, or one plus several high-risk conditions) Yes
ascvd-very-highNo one has reached this rule yetHigh-intensity statin; LDL-C <55, non-HDL-C <85; colchicine raised as a question
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
High-intensity statin therapy, aiming for LDL-C below 55 mg/dL (and non-HDL-C below 85).
You look to be in the guideline's "very high risk" secondary-prevention group — more than one major event, or one event plus several high-risk conditions — which carries the lowest goal in the guideline. If you are on a statin and still above goal, ezetimibe, bempedoic acid, or a PCSK9 inhibitor are the next steps rather than a reason to accept the number.
Ask a cardiologist about this one. Which secondary-prevention risk tier you sit in is a judgement this tool can only approximate. It knows about prior heart attack, stroke, and peripheral artery disease, but not how recent they were, whether you have familial hypercholesterolemia, or whether your LDL has stayed above 100 on maximal therapy — all of which feed the definition. Ask your cardiologist which goal applies to you.
Outcome-provenTested in randomised trials measuring heart attacks, strokes, or death, not a stand-in for them.· Class I· Level A· checked 2026-09-12
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class I
Ask your cardiologist whether low-dose colchicine is worth adding.
This is one of the more interesting additions to secondary prevention — colchicine at 0.5 mg daily reduced cardiovascular death, heart attack, stroke, or urgent revascularization by 31% in the LoDoCo2 trial, working on inflammation rather than on cholesterol. We stop short of suggesting it directly because it is cleared by the kidneys and interacts with several common drugs, including some statins, clarithromycin, and antifungals. Whether it suits you depends on your kidney function and everything else you take.
Why this is a question, not a recommendation. Being more specific would need everything else you're currently taking. That isn't something this tool asks for, so this one stays a question.
Outcome-provenTested in randomised trials measuring heart attacks, strokes, or death, not a stand-in for them.· Class 2a/2b· Level B-R· checked 2026-09-12
LoDoCo2 (NEJM 2020); ACC/AHA & ESC secondary prevention guidance · Class 2a/2b
“Prior heart attack and stroke, diabetes” — an illustrative profile, not a real user.
Asked after: Known cardiovascular disease
Cited by the recommendations above.
A trial that could change this, still running or reported too recently to be settled.
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Runs in lib/engine/lipidPathway.ts as ascvd-very-high.