Synthetic data only. Never enter patient information; nothing is sent or stored. For clinicians. Not FDA cleared.For licensed clinicians. Educational demonstration on synthetic data. Never enter real patient identifiers or protected health information: everything runs in your browser and nothing is sent or stored. Clinical decision support only; not FDA cleared; physician review is required.
CPE-007 · version 1.0.0
Cardiovascular Risk Pattern Engine: risk categories, enhancers and thresholds beyond the standard lipid panel
ACC/AHA categories applied to a risk you enter, with risk enhancers, Lp(a), apoB, calcium score and the 2022 LDL-C thresholds.
A standard lipid panel and a 10-year risk number leave out most of what the 2018 ACC/AHA guideline asks a physician to weigh: risk enhancers, Lp(a), apoB, coronary calcium, and the very-high-risk definition in secondary prevention. The Cardiovascular Risk Pattern Engine puts them in one place.
It does not calculate the 10-year risk. The Pooled Cohort Equations are race-specific and PREVENT is long, and Biod does not hand-code coefficients it cannot verify. You enter the risk from your own validated calculator, and the engine applies the categories that belong to it.
Playground
Load a synthetic case or type your own values. The result recomputes as you type, and every rule links to its page.
10-year risk category (Pooled Cohort Equations)
○ Low · <5%
Lifestyle emphasis
○ Borderline · 5 to <7.5%
Enhancers inform the discussion
○ Intermediate · 7.5 to <20%
Statin discussion favored; CAC can help
○ High · ≥20%
Statin benefit is greatest
No stage is assigned for the values entered.
Lipids and risk estimate
- <100
- 100–159
- 160–189
- ≥190
- <150
- 150–499
- ≥500
- ≥1000
This engine does not calculate it.
Patient
Recent ACS, prior MI, ischemic stroke, symptomatic PAD.
Age ≥65, HeFH, prior revascularization, diabetes, hypertension, CKD, smoking, HF.
Risk enhancers and extra tests
Treatment and familial risk
What it does
- Places adults in secondary prevention (very high risk or not), severe hypercholesterolemia, the diabetes statin group, or a 10-year risk band.
- Lists the 2018 risk enhancers present and shows how they weigh in borderline and intermediate risk.
- Adds Lp(a), apoB, hs-CRP and a coronary artery calcium score as decision aids, with the guideline reading of each.
- Applies the 2022 ACC thresholds (LDL-C 55 and 70 mg/dL) to patients on therapy, and prompts for overdue lipid monitoring.
- Raises severe hypertriglyceridemia and acute-event alerts, and prompts a secondary-cause and familial hypercholesterolemia review.
What it never does
- Calculate a 10-year risk with coefficients of its own.
- Apply the 5% / 7.5% / 20% categories to a PREVENT result.
- Name a drug or dose, or quote a trial's percentage reduction.
- Treat hs-CRP, Lp(a) or apoB as a treatment order.
Safety gates
These gates run before the pattern is shown, and urgent findings are displayed first.
- Chest pain suggesting an acute coronary syndrome, or stroke symptoms, ends risk estimation and raises an urgent alert.
- Triglycerides of 1,000 mg/dL or more raise an urgent alert; 500 to 999 raise a priority review.
- LDL-C of 190 mg/dL or more prompts a secondary-cause and familial hypercholesterolemia review.
- Patients under 20 are routed to the pediatric lipid pathway.
Inputs
- LDL-C, HDL-C, total cholesterol, triglycerides
- A 10-year ASCVD risk from a validated calculator, with the tool used
- Established ASCVD, events and high-risk conditions, diabetes
- Lp(a), apoB, hs-CRP, coronary calcium score
- Family history, blood pressure, smoking, therapy and monitoring dates
Scope
In scope
- Adults aged 20 and over
Routed out
- Patients under 20
The full rule catalog
20 active rules and 1 sandbox or context entries. Each has its own page with conditions, outputs and evidence. 21 of 21 active rules are exercised by at least one synthetic case.
Scope and validity
Risk category
Risk modifiers
Context triggers
Missing data
Calculations
Synthetic cases
Every case is synthetic. Open one to see the inputs, the full result and the rule trace; then change the values.
CVR-FX-01
Prior myocardial infarction, LDL-C 88 on a statin
Secondary prevention, not very high risk.
CVR-FX-02
Very high risk with LDL-C 62 on maximal therapy
Two events: the threshold is 55.
CVR-FX-03
LDL-C 205 and tendon xanthomas
Severe hypercholesterolemia.
CVR-FX-04
Diabetes at 58 with LDL-C 110
A guideline statin group.
CVR-FX-05
Intermediate risk 12% with enhancers
Family history and an hs-CRP of 3.4.
CVR-FX-06
Borderline risk 6.0%, no enhancers
Nothing to push the decision either way.
CVR-FX-07
Low risk 2.1%
A 45-year-old with a normal profile.
CVR-FX-08
High risk 23%
Above the 20% line.
CVR-FX-09
A PREVENT result is entered
The 2018 thresholds are not applied.
CVR-FX-10
Lp(a) 180 nmol/L
An elevated Lp(a) in intermediate risk.
CVR-FX-11
Lp(a) never measured, family history of premature ASCVD
A one-time measurement prompt.
CVR-FX-12
apoB 138 with LDL-C 115
Particle burden above what LDL-C suggests.
CVR-FX-13
Triglycerides 640 mg/dL
Severe hypertriglyceridemia.
CVR-FX-14
Triglycerides 1,320 mg/dL
Urgent range.
CVR-FX-15
Intermediate risk with a coronary calcium score of 0
May reasonably defer, with no exceptions present.
CVR-FX-16
Intermediate risk with a calcium score of 240
Favors a statin.
CVR-FX-17
On a statin, no lipid panel for 18 months
A monitoring gap.
CVR-FX-18
Chest pain right now
Not a risk-estimation context.
CVR-FX-19
A 31-year-old
Under 40 the 10-year estimate is not used.
CVR-FX-20
A 17-year-old is outside the adult pathway
Pediatric lipid pathway.
CVR-FX-21
An 84-year-old
Individualized decisions.
CVR-FX-22
Smoker with blood pressure 148/92
Modifiable factors.
CVR-FX-23
Metabolic syndrome with triglycerides 210, apoB not measured
A prompt for particle number.
CVR-FX-24
No lipid panel
Nothing to place the patient with.
CVR-FX-25
Secondary prevention at goal
LDL-C 48 in very high risk.
CVR-FX-26
Chronic kidney disease and non-HDL-C 210
Enhancers in intermediate risk.
Evidence
Guidelines and references the rules cite. Each rule page lists the ones that support it.
EV-ACCAHA-CHOL-2018Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082-e1143.
Supports: Risk categories, risk enhancers, statin benefit groups and the coronary-calcium decision aid Very-high-risk ASCVD definition
EV-ACC-ECDP-2022Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of ASCVD Risk. J Am Coll Cardiol. 2022;80(14):1366-1418.
Supports: LDL-C thresholds of 55 and 70 mg/dL for considering added therapy in ASCVD
EV-ACCAHA-PREV-2019Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140(11):e596-e646.
Supports: Primary prevention approach, risk estimation and modifiable risk factors
EV-PREVENT-2024Khan SS, Matsushita K, Sang Y, et al. Development and Validation of the American Heart Association's PREVENT Equations. Circulation. 2024;149(6):430-449.
Supports: Race-free risk equations whose output is not interchangeable with the Pooled Cohort Equations
EV-ESC-EAS-2019Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41(1):111-188.
Supports: At least one lifetime measurement of Lp(a)
EV-NLA-2015Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1. J Clin Lipidol. 2015;9(2):129-169.
Supports: apoB as a marker of atherogenic particle number, particularly with raised triglycerides
EV-JUPITER-2008Ridker PM, Danielson E, Fonseca FAH, et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. N Engl J Med. 2008;359(21):2195-2207.
Supports: hs-CRP ≥2 mg/L identified a population in whom a statin lowered events despite a low LDL-C
EV-ACC-TG-2021Virani SS, Morris PB, Agarwala A, et al. 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia. J Am Coll Cardiol. 2021;78(9):960-993.
Supports: Severe hypertriglyceridemia: ≥500 mg/dL carries a pancreatitis risk; ≥1000 mg/dL needs urgent attention
Frequently asked questions
Does the engine calculate my patient's 10-year risk?
No. It takes a risk you enter from a validated calculator. The Pooled Cohort Equations are race-specific and the PREVENT equations are long, and Biod will not hand-code coefficients it cannot verify.
Why are the 5%, 7.5% and 20% categories not applied to PREVENT?
The 2018 guideline set those thresholds for the Pooled Cohort Equations. PREVENT estimates are not interchangeable with them, so the engine reports the number and leaves the category to the physician, who applies the thresholds that suit the tool.
What are risk enhancers and how are they used?
They are the factors listed in the 2018 guideline that can tip a statin discussion in borderline and intermediate risk, such as family history of premature ASCVD, chronic kidney disease, metabolic syndrome, Lp(a) of 50 mg/dL or more, apoB of 130 or more and hs-CRP of 2 or more. They inform a shared decision and do not mandate treatment.
What LDL-C thresholds does it use on treatment?
For established ASCVD it uses the 2022 ACC pathway: 70 mg/dL, or 55 mg/dL in very-high-risk patients, as the point to consider added therapy. It reports that the threshold is exceeded; the choice of drug is the physician's.
How does it treat a coronary artery calcium score?
As a decision aid in borderline and intermediate risk. A score of 0 lowers risk and may allow deferring treatment, unless diabetes, family history or smoking weakens that. A score of 1 to 99 favors a statin, especially from age 55, and 100 or more favors one.
Specification status: Executable specification v1.0.0, authored by Biod from the narrative CPE-007 specification and current guidelines. Reviewed by Dr. Vinicius Amaral, D.O. Not for clinical production use.
Clinical review: Dr. Vinicius Amaral, D.O., Medical reviewer, 2026-10-03.
Keep going
CPE-002
Insulin Resistance–Associated Metabolic Pattern Engine
Guideline criteria for glycemia and metabolic syndrome. Insulin resistance itself is never diagnosed from one number.
CPE-005
MASLD Pattern Engine
Steatosis must be documented before MASLD is named. Fibrosis risk follows FIB-4, then elastography or ELF.
CPE-003
Chronic Kidney Disease Pattern Engine
No CKD label from a single result. Safety gates run first, then chronicity, then CGA.
Game
Pattern challenge
Guess what the engine will report.
Try Biod in your practice
The Clinical Intelligence Layer — transforming fragmented clinical information into structured intelligence for clinician review and action.