Heart Health

Borderline risk with a risk enhancer

A risk-enhancing factor that counts? (weighted — a single unconfirmed hs-CRP does not count until repeated) One or more present

Recommendationrisk-borderline-enhancersNo one has reached this rule yet

Statin reasonable to start now — no further testing needed to decide

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.

  • Reasonable to do

    Statin therapy is reasonable to start now.

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

    ACC/AHAClass 2aLevel B-NRESC/EASClass IIaLevel B
    Why, and the source

    Your estimated 10-year PREVENT ASCVD risk is 4.9% (the "borderline" 3%–5% band), and you have risk-enhancing factors that tip that decision toward treatment: Elevated lipoprotein(a) — 78 mg/dL. The guideline says risk enhancers move a borderline-risk person toward a statin without needing further testing.

    Where the guidelines stand

    ACC/AHA (US)

    ESC (Europe)

    • RecommendsClass IIaLevel B

      Risk modifiers should be considered for people near a treatment threshold. The ESC sorts risk with SCORE2, not the PREVENT equations used here, so the tiers line up only roughly.

      2025 ESC/EAS focused update on dyslipidaemias · 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-NR

An example person who reaches it

“Borderline risk + high Lp(a)” — an illustrative profile, not a real user.

58-year-old manBP 132/82LDL 140Lp(a) 78 mg/dL10-yr PREVENT-ASCVD 4.9%

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 risk 3–5% (borderline)
  3. A risk-enhancing factor that counts? (weighted — a single unconfirmed hs-CRP does not count until repeated)One or more present ← this rule
  4. Coronary artery calcium (CAC) score? (further testing beyond basic labs)Not measured
  5. hs-CRP ≥2 mg/L, confirmed on a repeat test? (further testing beyond basic labs)Not measured

Where it sits

Asked after: 10-year risk 3% to under 5%

Sources

Cited by the recommendations above.

What we are least sure of here

  • Q6Is the major / standard / provisional weighting of risk enhancers the right shape, and are the assignments right?

Review this rule

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Runs in lib/engine/lipidPathway.ts as risk-borderline-enhancers.