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CPE-007 · synthetic case CVR-FX-10
Lp(a) 180 nmol/L
An elevated Lp(a) in intermediate risk.
Purpose: An elevated Lp(a) in intermediate risk.
Inputs the engine received
Lipids and risk estimate
- LDL-C
- 118 mg/dL
- Total cholesterol
- 200 mg/dL
- HDL-C
- 52 mg/dL
- 10-year ASCVD risk (from your calculator)
- 9 %
- Calculator used
- Pooled Cohort
Patient
- Age
- 54 years
Risk enhancers and extra tests
- Lp(a)
- 180
- Lp(a) unit
- nmol/L
What the engine reports
Detected clinical pattern
Intermediate 10-Year Risk (7.5% to <20%)
Category from the entered Pooled Cohort Equations risk. 1 risk enhancer(s) present.
- 10-year risk: 10-year risk 9% · intermediate
Why this pattern was identified
- Risk enhancers. 1 present: Lp(a) 180 nmol/L. In intermediate risk they favor a statin discussion; they inform a shared decision and do not mandate treatment.
Calculations
- Non-HDL cholesterol
- 148 mg/dL
Total cholesterol minus HDL-C.
Differentials, pitfalls and contradicting signals
- Lp(a) is largely genetically determined and does not change with statins; it informs overall risk and relatives' risk.
Evidence and rule trace · 4 rules
CV-0410-year ASCVD risk category
Inputs: 10-year risk 9% (Pooled Cohort Equations)
Risk category: intermediate.
CV-05Risk enhancers present
Inputs: intermediate risk · Lp(a) 180 nmol/L
Risk enhancers favor a statin discussion.
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)
✓ 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
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
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-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.
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