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 reasonable because you have diabetes and additional risk on top of it.
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
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.
ACC/AHA (US)
High-intensity treatment is graded as reasonable, not recommended, when diabetes comes with multiple other risk factors.
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
At least a moderate-intensity statin for everyone aged 40 to 75 with diabetes
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)
Type 2 diabetes at high or very high risk: at least a 50% LDL-C cut, with LDL-C below 70 (high risk) or below 55 (very high risk).
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 2a · Level B-R
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
Your triglycerides (240 mg/dL) are above the normal range (under 150).
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
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.
ACC/AHA (US)
Graded for fasting triglycerides of 150 to 499: a diet low in added sugar, refined carbohydrate and saturated fat, minimal alcohol, activity and weight loss.
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
2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class 1 · Level A
Your triglyceride-to-HDL ratio is 5.5, a free extra read on the same finding.
Improves test numbersShown: this ratio tracks insulin resistance and small, dense LDL in validation studies. Not shown: that treating the ratio itself, apart from the triglycerides and weight driving it, changes outcomes.
A ratio this high (5.5, above the 3.5 cut point) usually means your LDL particles skew small and dense, and that insulin resistance is driving the pattern. That is the same process behind the triglyceride number above, seen from a different angle. It is not a separate problem to treat on its own, and it doesn't carry independent guideline weight the way an ApoB or Lp(a) result does; it's context for what's already been flagged. What moves it is the same list: less refined carbohydrate and alcohol, more activity, and weight loss if that applies. If you want the more direct, guideline-recognized measure of the same underlying risk, ApoB counts the particles themselves rather than inferring their size.
Ask about icosapent ethyl (Vascepa) — a prescription omega-3 that reduced cardiovascular events by 25% in people in your exact situation.
Proven in trialsShown: 25% fewer heart attacks and strokes in one large trial. A similar omega-3 trial found no benefit, so some doubt remains.
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.
ESC (Europe)
High-dose icosapent ethyl with a statin in high or very high risk patients with fasting triglycerides 135 to 499 mg/dL.
2025 ESC/EAS focused update on dyslipidaemias · Recommendation tables · class and level read from the guideline tables on 2026-09-30
REDUCE-IT trial (NEJM 2019) — icosapent ethyl · Class 2b · Level B-R
“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.