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CPE-007 · synthetic case CVR-FX-23

Metabolic syndrome with triglycerides 210, apoB not measured

A prompt for particle number.

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

Purpose: A prompt for particle number.

Inputs the engine received

Lipids and risk estimate

LDL-C
118 mg/dL
Total cholesterol
196 mg/dL
HDL-C
36 mg/dL
Triglycerides
210 mg/dL
10-year ASCVD risk (from your calculator)
7.8 %
Calculator used
Pooled Cohort

Patient

Age
50 years

Risk enhancers and extra tests

Metabolic syndrome
Yes

What the engine reports

Detected clinical pattern

Intermediate 10-Year Risk (7.5% to <20%)

Category from the entered Pooled Cohort Equations risk. 2 risk enhancer(s) present.

  • 10-year risk: 10-year risk 7.8% · intermediate

Why this pattern was identified

  • Risk enhancers. 2 present: metabolic syndrome; triglycerides 210 mg/dL (≥175, if persistent). In intermediate risk they favor a statin discussion; they inform a shared decision and do not mandate treatment.

Calculations

Non-HDL cholesterol
160 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 · 5 rules

CV-CALC-01Derived value

Inputs: total cholesterol 196 · HDL-C 36

Non-HDL cholesterol 160 mg/dL.

CV-0410-year ASCVD risk category

Inputs: 10-year risk 7.8% (Pooled Cohort Equations)

Risk category: intermediate.

CV-05Risk enhancers present

Inputs: intermediate risk · metabolic syndrome · triglycerides 210 mg/dL (≥175, if persistent)

Risk enhancers favor a statin discussion.

CV-06Lipoprotein(a)

Inputs: Lp(a) never measured

One-time measurement is recommended by several societies.

CV-07Apolipoprotein B

Inputs: apoB not measured · metabolic syndrome

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-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.
  • 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

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

Intermediate 10-Year Risk (7.5% to <20%)

Category from the entered Pooled Cohort Equations risk. 2 risk enhancer(s) present.

  • 10-year risk: 10-year risk 7.8% · intermediate

Why this pattern was identified

  • Risk enhancers. 2 present: metabolic syndrome; triglycerides 210 mg/dL (≥175, if persistent). In intermediate risk they favor a statin discussion; they inform a shared decision and do not mandate treatment.

Calculations

Non-HDL cholesterol
160 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 · 5 rules

CV-CALC-01Derived value

Inputs: total cholesterol 196 · HDL-C 36

Non-HDL cholesterol 160 mg/dL.

CV-0410-year ASCVD risk category

Inputs: 10-year risk 7.8% (Pooled Cohort Equations)

Risk category: intermediate.

CV-05Risk enhancers present

Inputs: intermediate risk · metabolic syndrome · triglycerides 210 mg/dL (≥175, if persistent)

Risk enhancers favor a statin discussion.

CV-06Lipoprotein(a)

Inputs: Lp(a) never measured

One-time measurement is recommended by several societies.

CV-07Apolipoprotein B

Inputs: apoB not measured · metabolic syndrome

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-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.
  • 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-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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