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CPE-007 · synthetic case CVR-FX-13

Triglycerides 640 mg/dL

Severe hypertriglyceridemia.

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

Purpose: Severe hypertriglyceridemia.

Inputs the engine received

Lipids and risk estimate

LDL-C
90 mg/dL
Total cholesterol
240 mg/dL
HDL-C
33 mg/dL
Triglycerides
640 mg/dL

Patient

Age
47 years

What the engine reports

Priority

Triglycerides ≥500 mg/dL

CV-12

Pancreatitis risk rises with severe hypertriglyceridemia, and cardiovascular risk estimation is secondary to that risk in this range.

Detected clinical pattern

10-Year Risk Estimate Needed

Enter a 10-year risk from a validated calculator. This engine does not calculate it.

Why this pattern was identified

  • Risk enhancers listed. non-HDL-C 207 mg/dL (190–219); triglycerides 640 mg/dL (≥175, if persistent). The guideline uses enhancers mainly in borderline and intermediate risk.

Calculations

Non-HDL cholesterol
207 mg/dL

Total cholesterol minus HDL-C.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Physician review of pancreatitis risk and of secondary causes of hypertriglyceridemia.
  2. 2Consider a one-time Lp(a) measurement.ESC/EAS 2019; listed as an enhancer by ACC/AHA 2018.

Differentials, pitfalls and contradicting signals

  • Secondary causes to review: hypothyroidism, diabetes, nephrotic syndrome, cholestasis, obesity, alcohol and medications.

Missing information

  • A 10-year ASCVD risk from a validated calculator (Pooled Cohort Equations or PREVENT). This engine does not calculate it.
Evidence and rule trace · 5 rules

CV-CALC-01Derived value

Inputs: total cholesterol 240 · HDL-C 33

Non-HDL cholesterol 207 mg/dL.

CV-06Lipoprotein(a)

Inputs: Lp(a) never measured

One-time measurement is recommended by several societies.

CV-12Severe hypertriglyceridemia

Inputs: triglycerides 640 mg/dL

Priority: severe hypertriglyceridemia.

CV-13Secondary causes of dyslipidemia

Inputs: triglycerides 640

Secondary causes should be reviewed.

CV-MISS-01Data needed to place the patient

Inputs: no 10-year risk estimate

Data needed to place the patient.

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-ACC-TG-2021 · Virani 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.

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

Priority

Triglycerides ≥500 mg/dL

CV-12

Pancreatitis risk rises with severe hypertriglyceridemia, and cardiovascular risk estimation is secondary to that risk in this range.

Detected clinical pattern

10-Year Risk Estimate Needed

Enter a 10-year risk from a validated calculator. This engine does not calculate it.

Why this pattern was identified

  • Risk enhancers listed. non-HDL-C 207 mg/dL (190–219); triglycerides 640 mg/dL (≥175, if persistent). The guideline uses enhancers mainly in borderline and intermediate risk.

Calculations

Non-HDL cholesterol
207 mg/dL

Total cholesterol minus HDL-C.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Physician review of pancreatitis risk and of secondary causes of hypertriglyceridemia.
  2. 2Consider a one-time Lp(a) measurement.ESC/EAS 2019; listed as an enhancer by ACC/AHA 2018.

Differentials, pitfalls and contradicting signals

  • Secondary causes to review: hypothyroidism, diabetes, nephrotic syndrome, cholestasis, obesity, alcohol and medications.

Missing information

  • A 10-year ASCVD risk from a validated calculator (Pooled Cohort Equations or PREVENT). This engine does not calculate it.
Evidence and rule trace · 5 rules

CV-CALC-01Derived value

Inputs: total cholesterol 240 · HDL-C 33

Non-HDL cholesterol 207 mg/dL.

CV-06Lipoprotein(a)

Inputs: Lp(a) never measured

One-time measurement is recommended by several societies.

CV-12Severe hypertriglyceridemia

Inputs: triglycerides 640 mg/dL

Priority: severe hypertriglyceridemia.

CV-13Secondary causes of dyslipidemia

Inputs: triglycerides 640

Secondary causes should be reviewed.

CV-MISS-01Data needed to place the patient

Inputs: no 10-year risk estimate

Data needed to place the patient.

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-ACC-TG-2021 · Virani 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.

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-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.

All cardio cases

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