Your situation (severe hypercholesterolemia short-circuits the risk score) LDL-C ≥190 mg/dL
ldl-190No one has reached this rule yetHigh-intensity statin now, regardless of calculated risk (severe hypercholesterolemia)
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 now, regardless of your calculated risk score.
Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.
Your LDL-C (212 mg/dL) is at or above 190 — "severe hypercholesterolemia," often inherited (familial hypercholesterolemia). The guideline treats this as an independent reason to start a high-intensity statin without running a risk calculation, aiming for at least a 50% LDL-C reduction. Ask your doctor whether ezetimibe or a PCSK9 inhibitor should be added, and whether first-degree relatives should be screened.
ACC/AHA (US)
High-intensity statin therapy now, regardless of your calculated risk score.
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, a PCSK9 antibody or bempedoic acid to reach LDL-C below 100 when there are no other risk factors
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
The same add-ons to reach LDL-C below 70 with familial hypercholesterolemia, other risk factors or coronary calcium
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)
High-intensity statin to the highest tolerated dose; FH is diagnosed with clinical criteria and DNA confirmation where possible (Class I, C).
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 B-R
“Very high LDL” — 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 ldl-190.