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CPE-007 · synthetic case CVR-FX-04

Diabetes at 58 with LDL-C 110

A guideline statin group.

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

Purpose: A guideline statin group.

Inputs the engine received

Lipids and risk estimate

LDL-C
110 mg/dL
Total cholesterol
185 mg/dL
HDL-C
42 mg/dL
Triglycerides
180 mg/dL

Patient

Age
58 years
Diabetes
Yes

What the engine reports

Detected clinical pattern

Diabetes, Age 40–75 — Guideline Statin Group

A guideline-supported statin group; a shared decision with the patient.

  • Category: Diabetes, age 40–75

Why this pattern was identified

  • Diabetes aged 40 to 75. The 2018 guideline supports statin therapy in this group; multiple risk factors or risk enhancers favor a stronger regimen. A shared decision with the patient.
  • Risk enhancers listed. triglycerides 180 mg/dL (≥175, if persistent). The guideline uses enhancers mainly in borderline and intermediate risk.

Calculations

Non-HDL cholesterol
143 mg/dL

Total cholesterol minus HDL-C.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Consider a one-time Lp(a) measurement.ESC/EAS 2019; listed as an enhancer by ACC/AHA 2018.
  2. 2Consider apoB to clarify atherogenic particle burden.NLA 2015.
Evidence and rule trace · 4 rules

CV-CALC-01Derived value

Inputs: total cholesterol 185 · HDL-C 42

Non-HDL cholesterol 143 mg/dL.

CV-03Diabetes aged 40 to 75

Inputs: diabetes · age 58

Statin therapy is guideline-supported in this group.

CV-06Lipoprotein(a)

Inputs: Lp(a) never measured

One-time measurement is recommended by several societies.

CV-07Apolipoprotein B

Inputs: apoB not measured · diabetes

apoB can clarify particle burden.

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-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.
  • EV-NLA-2015 · Jacobson 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.

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

Diabetes, Age 40–75 — Guideline Statin Group

A guideline-supported statin group; a shared decision with the patient.

  • Category: Diabetes, age 40–75

Why this pattern was identified

  • Diabetes aged 40 to 75. The 2018 guideline supports statin therapy in this group; multiple risk factors or risk enhancers favor a stronger regimen. A shared decision with the patient.
  • Risk enhancers listed. triglycerides 180 mg/dL (≥175, if persistent). The guideline uses enhancers mainly in borderline and intermediate risk.

Calculations

Non-HDL cholesterol
143 mg/dL

Total cholesterol minus HDL-C.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Consider a one-time Lp(a) measurement.ESC/EAS 2019; listed as an enhancer by ACC/AHA 2018.
  2. 2Consider apoB to clarify atherogenic particle burden.NLA 2015.
Evidence and rule trace · 4 rules

CV-CALC-01Derived value

Inputs: total cholesterol 185 · HDL-C 42

Non-HDL cholesterol 143 mg/dL.

CV-03Diabetes aged 40 to 75

Inputs: diabetes · age 58

Statin therapy is guideline-supported in this group.

CV-06Lipoprotein(a)

Inputs: Lp(a) never measured

One-time measurement is recommended by several societies.

CV-07Apolipoprotein B

Inputs: apoB not measured · diabetes

apoB can clarify particle burden.

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-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.
  • EV-NLA-2015 · Jacobson 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.

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-03

LDL-C 205 and tendon xanthomas

Severe hypercholesterolemia.

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

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