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).
Proven in trialsTrials counted real events, like heart attacks, strokes, or deaths, and this changed them.
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.
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.
ACC/AHA (US)
High-intensity statin therapy, aiming for LDL-C below 55 mg/dL (and non-HDL-C below 85).
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
Adding ezetimibe and/or a PCSK9 antibody to reach LDL-C below 55
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Graded separately within the same recommendation · class and level read from the guideline tables on 2026-09-30
Adding bempedoic acid, or inclisiran if an antibody is not tolerated or available
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Graded separately within the same recommendation · class and level read from the guideline tables on 2026-09-30
ESC (Europe)
Secondary prevention at very high risk: at least a 50% cut and LDL-C below 55 mg/dL; a PCSK9 inhibitor is also Class I, Level A when the goal is missed on a statin plus ezetimibe.
2019 ESC/EAS dyslipidaemia guidelines · Recommendation tables · class and level read from the guideline tables on 2026-09-30
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class 1 · Level A
Ask your cardiologist whether low-dose colchicine is worth adding.
Proven in trialsShown: 23% to 31% fewer heart attacks, strokes, and heart deaths in two trials of people with heart disease.
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.
ACC/AHA (US)
ACC/AHA 2023 chronic coronary disease guideline. The ESC grades it higher.
LoDoCo2 (NEJM 2020); ACC/AHA & ESC secondary prevention guidance · Recommendation behind this rule · class and level read from the guideline tables on 2026-09-30
ESC (Europe)
Low-dose colchicine 0.5 mg daily should be considered in chronic coronary syndrome to reduce MI, stroke and revascularization.
2024 ESC chronic coronary syndromes guidelines · Recommendation tables · class and level read from the guideline tables on 2026-09-30
Why this is a question. It would need everything else you're currently taking. This tool doesn't ask for that, so it stays a question.
LoDoCo2 (NEJM 2020); ACC/AHA & ESC secondary prevention guidance · Class 2b · Level B-R
“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.