Heart Health

Low risk with a major risk enhancer

Age 30–59 with high lifetime risk, or a major risk enhancer (e.g. premature family history, South Asian ancestry) or elevated Lp(a)? Yes

Recommendationrisk-low-enhancersFewer than 5 people have reached this rule so far

Discuss a statin anyway — the calculator under-weights these

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.

  • Guideline text, not a graded recommendation

    Your calculated risk is low, but talk to your doctor about a statin anyway — the calculator under-weights the factors you have.

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

    Why, and the source

    Your estimated 10-year PREVENT-ASCVD risk is 1.2%, below the 3% threshold — but the equations are blind to what you have: south asian ancestry. A low score does not rule out benefit from a statin when the thing raising your risk is something the calculator never sees.

    Where the guidelines stand

    ACC/AHA (US)

    • Discusses it, with no class or level

      The guideline says statins may be reasonable at low risk with a strong family history of early heart disease or very high Lp(a), but it does not give that statement a class or level.

      2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia · Recommendation behind this rule · carried over from an earlier review, not yet re-read

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

An example person who reaches it

“Low calculated risk, South Asian ancestry” — an illustrative profile, not a real user.

46-year-old manBP 122/76LDL 104South Asian ancestry10-yr PREVENT-ASCVD 1.2%

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 risk <3%
  3. Age 30–59 with high lifetime risk, or a major risk enhancer (e.g. premature family history, South Asian ancestry) or elevated Lp(a)?Yes ← this rule
  4. Coronary artery calcium (CAC) score? (further testing beyond basic labs)Not measured

Where it sits

Asked after: 10-year risk under 3%

Then asks: Coronary artery calcium (CAC) score? (further testing beyond basic labs)

Sources

Cited by the recommendations above.

What we are least sure of here

  • Q4South Asian ancestry as a qualitative major enhancer, or an adjusted numeric range alongside the base number?
  • 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-low-enhancers.