Your situation (severe hypercholesterolemia short-circuits the risk score) Diabetes, age 40–75
diabetes-statinNo one has reached this rule yetStatin recommended on the diagnosis alone; risk score sets the intensity
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.
A high-intensity statin is recommended because you have diabetes and additional risk on top of it.
Diabetes between ages 40 and 75 is itself a statin indication in the guideline. The risk score helps choose the intensity, but it doesn't decide whether to treat.
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class I
Also ask specifically about an SGLT2 inhibitor or a GLP-1 receptor agonist for the diabetes itself — some of these lower cardiovascular risk beyond their effect on blood sugar.
For people with type 2 diabetes and either established cardiovascular disease, kidney disease, or high cardiovascular risk, these two drug classes have outcome trials showing fewer cardiovascular events, and guidelines now favor them over older glucose-lowering drugs for exactly that reason.
ADA Standards of Care — cardiovascular and kidney disease management · Class I (in diabetes with CV/kidney risk)
Your triglycerides (240 mg/dL) are above the normal range (under 150).
Elevated triglycerides usually track with insulin resistance, alcohol, and refined carbohydrate rather than dietary fat. Cutting added sugar and alcohol, losing excess weight, and increasing activity move this number faster than almost any other lipid.
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Lifestyle first
Ask about icosapent ethyl (Vascepa) — a prescription omega-3 that reduced cardiovascular events by 25% in people in your exact situation.
You're on a statin with triglycerides of 240 mg/dL and diabetes. That's the REDUCE-IT population. Note this is specifically prescription icosapent ethyl — over-the-counter fish oil supplements did not show the same benefit and are not a substitute. A fair caveat worth knowing: REDUCE-IT's placebo was mineral oil, which itself raised several inflammatory and lipid markers in the comparison group, and some cardiologists argue this inflated the apparent benefit. The counter-evidence doesn't settle it either way: STRENGTH tested a different combination (EPA plus DHA, against a corn-oil placebo) and found no benefit at all, which is equally consistent with EPA alone being the active ingredient and DHA blunting it, rather than the placebo explaining everything. No trial has been run that would resolve this cleanly. Icosapent ethyl remains the only omega-3 approach with a positive outcomes trial and a guideline recommendation, but treat the 25% figure as real with somewhat more uncertainty around it than a typical trial this size would carry.
“Diabetes, already on a statin” — an illustrative profile, not a real user.
Asked after: No known cardiovascular disease
Cited by the recommendations above.
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Runs in lib/engine/lipidPathway.ts as diabetes-statin.