Heart Health

Borderline risk, no risk enhancers

A risk-enhancing factor that counts? (weighted — a single unconfirmed hs-CRP does not count until repeated) None on record

Recommendationrisk-borderline-no-enhancersNo one has reached this rule yet

Statin optional — a CAC score or a confirmed hs-CRP can settle it

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 can be considered, aiming for LDL-C below 100 mg/dL (and non-HDL-C below 130).

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

    ACC/AHAClass 2aLevel A
    Why, and the source

    Your estimated 10-year PREVENT ASCVD risk is 4.0%, in the "borderline" 3%–5% range with no risk-enhancing factors on record. This is the band where the decision is genuinely a judgment call — a CAC score or hs-CRP (below) can settle it.

    Where the guidelines stand

    ACC/AHA (US)

    • RecommendsClass 2aLevel A

      The 2a grade covers the intensity of a moderate-intensity statin once a decision to treat has been made. The guideline does not grade starting a statin at borderline risk when there are no risk enhancers; that is where a calcium score is meant to decide.

      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

    • RecommendsClass 1Level B-R

      Coronary calcium scoring when the decision stays uncertain

      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

    2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Class 2a · Level A

An example person who reaches it

“Borderline risk, nothing else on file” — an illustrative profile, not a real user.

57-year-old manBP 128/80LDL 13810-yr PREVENT-ASCVD 4.0%

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)None on record ← 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-no-enhancers.