Heart Health

10-year risk 10% or more

Your situation (severe hypercholesterolemia short-circuits the risk score) 10-yr PREVENT-ASCVD ≥10% (high)

Recommendationrisk-10plusNo one has reached this rule yet

High-intensity statin; LDL-C <70, non-HDL-C <100

Clinical review

All reviewers

No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.

What someone who reaches this rule is told

Word for word, as generated for the example person below. Figures in the text are theirs.

  • Strongly recommended

    A high-intensity statin should be started, aiming for LDL-C below 70 mg/dL (and non-HDL-C below 100).

    Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.

    ACC/AHAClass 1Level AESC/EASClass ILevel A
    Why, and the source

    Your estimated 10-year PREVENT-ASCVD risk is 13.2%, which is the guideline's "high risk" category — 10% or above. This is the primary-prevention group that carries the same LDL goal as established disease, and where a high-intensity statin rather than a moderate one is the starting point.

    Where the guidelines stand

    ACC/AHA (US)

    ESC (Europe)

    • RecommendsClass ILevel A

      At high risk, at least a 50% LDL-C cut and a goal below 70 mg/dL. The ESC sorts risk with SCORE2, not the PREVENT equations used here, so the tiers line up only roughly.

      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

  • A factor that changes the decision

    Your risk-enhancing factors reinforce this: Diabetes, age over 40.

    Expert guidelinesOfficial guidelines recommend it, based on trials plus expert judgment.

    Why, and the source

    At this risk level they do not change whether to treat — that is already settled — but they matter for how hard, and for whether an add-on is needed to reach goal.

    Where the guidelines stand

    ACC/AHA (US)

    2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia

An example person who reaches it

“Atrial fibrillation, blood thinner not yet discussed” — an illustrative profile, not a real user.

77-year-old womanBP 142/86 on medicationLDL 130diabetes, A1c 6.8%atrial fibrillation, diagnosed10-yr PREVENT-ASCVD 13.2%

Their path through cholesterol

  1. Known ASCVD (prior heart attack, stroke, or revascularization)?No
  2. Your situation (severe hypercholesterolemia short-circuits the risk score)10-yr PREVENT-ASCVD ≥10% (high) ← this rule

Where it sits

Asked after: No known cardiovascular disease

Sources

Cited by the recommendations above.

Being tested further

A trial that could change this, still running or reported too recently to be settled.

  • CORALreef Outcomes — The new daily pill version of a PCSK9 inhibitor lowers LDL as much as the injections. Does it also prevent heart attacks and strokes?

What we are least sure of here

  • Q7Are 3% and 5% the right PREVENT-based bands? The load-bearing assumption of the whole product.

Review this rule

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Runs in lib/engine/lipidPathway.ts as risk-10plus.