Start Free

Synthetic data only. Never enter patient information; nothing is sent or stored. For clinicians. Not FDA cleared.

CPE-007 · synthetic case CVR-FX-03

LDL-C 205 and tendon xanthomas

Severe hypercholesterolemia.

Synthetic · no real patientAuthored by Biod · reviewed by Dr. AmaralCardio engine v1.0.0

Purpose: Severe hypercholesterolemia.

Inputs the engine received

Lipids and risk estimate

LDL-C
205 mg/dL
Total cholesterol
290 mg/dL
HDL-C
46 mg/dL

Patient

Age
33 years

Risk enhancers and extra tests

Family history of premature ASCVD
Yes

Treatment and familial risk

Tendon xanthomas
Yes

What the engine reports

Detected clinical pattern

Severe Hypercholesterolemia (LDL-C ≥190 mg/dL)

A guideline statin group without a risk estimate; secondary causes and familial hypercholesterolemia to review.

  • Category: Severe hypercholesterolemia

Why this pattern was identified

  • Severe hypercholesterolemia. LDL-C 205 mg/dL (≥190). The 2018 guideline supports statin therapy without a risk estimate in adults 20–75 and calls for exclusion of secondary causes.
  • Risk enhancers listed. family history of premature ASCVD. The guideline uses enhancers mainly in borderline and intermediate risk.

Calculations

Non-HDL cholesterol
244 mg/dL

Total cholesterol minus HDL-C.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Exclude secondary causes, and consider familial hypercholesterolemia.
  2. 2Consider clinical scoring (for example the Dutch Lipid Clinic Network) and cascade screening of relatives.
  3. 3Consider a one-time Lp(a) measurement.ESC/EAS 2019; listed as an enhancer by ACC/AHA 2018.

Differentials, pitfalls and contradicting signals

  • Under 40, lifetime risk, family history and severe hypercholesterolemia matter more than a 10-year estimate.
  • Secondary causes to review: hypothyroidism, diabetes, nephrotic syndrome, cholestasis, obesity, alcohol and medications.
Evidence and rule trace · 6 rules

CV-CALC-01Derived value

Inputs: total cholesterol 290 · HDL-C 46

Non-HDL cholesterol 244 mg/dL.

CV-SCOPE-02Age bands that change the approach

Inputs: age 33

10-year risk is not estimated under 40.

CV-02Severe hypercholesterolemia

Inputs: LDL-C 205 mg/dL

Severe hypercholesterolemia.

CV-06Lipoprotein(a)

Inputs: Lp(a) never measured

One-time measurement is recommended by several societies.

CV-13Secondary causes of dyslipidemia

Inputs: LDL-C 205

Secondary causes should be reviewed.

CV-14Familial hypercholesterolemia suspected

Inputs: LDL-C 205

Familial hypercholesterolemia is suspected.

Evidence

  • EV-ACCAHA-CHOL-2018 · Grundy 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.
  • EV-ACCAHA-PREV-2019 · Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140(11):e596-e646.
  • EV-ESC-EAS-2019 · Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41(1):111-188.

Physician adjudication required. Clinical decision support for physician review. This output organizes guideline categories and risk modifiers. It does not calculate a 10-year risk, select a drug or dose, or replace a shared decision with the patient. Physician adjudication is required.

Change the values

The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.

10-year risk category (Pooled Cohort Equations)

  1. ○ Low · <5%

    Lifestyle emphasis

  2. ○ Borderline · 5 to <7.5%

    Enhancers inform the discussion

  3. ○ Intermediate · 7.5 to <20%

    Statin discussion favored; CAC can help

  4. ○ 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.

Calculator used
Patient

Recent ACS, prior MI, ischemic stroke, symptomatic PAD.

Age ≥65, HeFH, prior revascularization, diabetes, hypertension, CKD, smoking, HF.

Risk enhancers and extra tests
Lp(a) unit
Treatment and familial risk

Live result · computed in your browser

Detected clinical pattern

Severe Hypercholesterolemia (LDL-C ≥190 mg/dL)

A guideline statin group without a risk estimate; secondary causes and familial hypercholesterolemia to review.

  • Category: Severe hypercholesterolemia

Why this pattern was identified

  • Severe hypercholesterolemia. LDL-C 205 mg/dL (≥190). The 2018 guideline supports statin therapy without a risk estimate in adults 20–75 and calls for exclusion of secondary causes.
  • Risk enhancers listed. family history of premature ASCVD. The guideline uses enhancers mainly in borderline and intermediate risk.

Calculations

Non-HDL cholesterol
244 mg/dL

Total cholesterol minus HDL-C.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Exclude secondary causes, and consider familial hypercholesterolemia.
  2. 2Consider clinical scoring (for example the Dutch Lipid Clinic Network) and cascade screening of relatives.
  3. 3Consider a one-time Lp(a) measurement.ESC/EAS 2019; listed as an enhancer by ACC/AHA 2018.

Differentials, pitfalls and contradicting signals

  • Under 40, lifetime risk, family history and severe hypercholesterolemia matter more than a 10-year estimate.
  • Secondary causes to review: hypothyroidism, diabetes, nephrotic syndrome, cholestasis, obesity, alcohol and medications.
Evidence and rule trace · 6 rules

CV-CALC-01Derived value

Inputs: total cholesterol 290 · HDL-C 46

Non-HDL cholesterol 244 mg/dL.

CV-SCOPE-02Age bands that change the approach

Inputs: age 33

10-year risk is not estimated under 40.

CV-02Severe hypercholesterolemia

Inputs: LDL-C 205 mg/dL

Severe hypercholesterolemia.

CV-06Lipoprotein(a)

Inputs: Lp(a) never measured

One-time measurement is recommended by several societies.

CV-13Secondary causes of dyslipidemia

Inputs: LDL-C 205

Secondary causes should be reviewed.

CV-14Familial hypercholesterolemia suspected

Inputs: LDL-C 205

Familial hypercholesterolemia is suspected.

Evidence

  • EV-ACCAHA-CHOL-2018 · Grundy 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.
  • EV-ACCAHA-PREV-2019 · Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140(11):e596-e646.
  • EV-ESC-EAS-2019 · Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41(1):111-188.

Physician adjudication required. Clinical decision support for physician review. This output organizes guideline categories and risk modifiers. It does not calculate a 10-year risk, select a drug or dose, or replace a shared decision with the patient. Physician adjudication is required.

More cardio cases

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-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.

All cardio cases

Try Biod in your practice

The Clinical Intelligence Layer — transforming fragmented clinical information into structured intelligence for clinician review and action.

Start Free for 3 Months (opens in a new tab)Send us a message

Contact Biod