Risk Stratification Flowchart

Visual representation of the risk stratification process described in 04 — Risk Stratification.

The process is split into six short charts. Parts 1 and 2 sort every patient into a starting risk category. Parts 3–6 continue for patients whose category needs more testing before treatment is decided.

Entry point or goal reached Assessment step Decision question Treatment started or test ordered Caution: needs further evaluation High risk: urgent or aggressive action Labs, scheduling, or administrative step Continues in another chart on this page On a small screen, swipe sideways on a chart to see all of it.

Part 1 — Established ASCVD or LDL-C ≥ 190 

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    START[Patient Assessed]:::entry --> ASCVD{Established<br>ASCVD?}

    ASCVD -->|Yes| VERYHIGH["Very High Risk<br>LDL-C &lt; 55 mg/dL<br>ApoB &lt; 65 mg/dL"]:::urgent
    ASCVD -->|No| LDL190{LDL-C<br>≥ 190 mg/dL?}

    LDL190 -->|Yes| FHEVAL[Evaluate for FH<br>See FH Pathway]:::caution
    FHEVAL --> HIGH["High Risk<br>LDL-C &lt; 70 mg/dL<br>ApoB &lt; 80 mg/dL"]:::urgent
    LDL190 -->|No| P2[Continue to Part 2:<br>PREVENT Risk]:::link

    VERYHIGH --> TX["Proceed to<br>Treatment Pathway<br>(document 05)"]:::treat
    HIGH --> TX

Part 2 — PREVENT Risk Category 

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    PREVENT[Calculate<br>PREVENT Risk]:::assess --> RISKCAT{10-Year<br>Risk Category}

    RISKCAT -->|≥ 10%| HIGH["High Risk<br>LDL-C &lt; 70 mg/dL<br>ApoB &lt; 80 mg/dL"]:::urgent
    RISKCAT -->|5–9.9%| INTERMEDIATE[Intermediate<br>Risk]:::caution
    RISKCAT -->|3–4.9%| BORDERLINE[Borderline<br>Risk]:::caution
    RISKCAT -->|"&lt; 3%"| LOW[Low Risk]:::entry

    HIGH --> TX["Proceed to<br>Treatment Pathway<br>(document 05)"]:::treat
    INTERMEDIATE --> P3[Continue to Part 3:<br>Risk Enhancers]:::link
    BORDERLINE --> P3
    LOW --> P6[Continue to Part 6:<br>Confirm Low Risk]:::link

Part 3 — Risk Enhancers and Advanced Testing 

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    IN[Borderline or<br>Intermediate Risk]:::caution --> ENHANCERS{Risk<br>Enhancers<br>Present?}

    ENHANCERS -->|Yes, ≥ 1| ADVANCED[Order Advanced<br>Testing]:::treat
    ENHANCERS -->|No| SDM[Shared Decision<br>Making re: Statin]:::assess

    ADVANCED --> APOB[ApoB]:::assess
    ADVANCED --> LPA["Lp(a)<br>if not done"]:::assess
    ADVANCED --> CAC[CAC Score]:::assess

    APOB --> INTEGRATE[Integrate<br>All Results]:::assess
    LPA --> INTEGRATE
    CAC --> INTEGRATE
    INTEGRATE --> P4[Continue to Part 4:<br>CAC Result]:::link

    SDM --> FINALCAT[Assign Final<br>Risk Category]:::treat
    FINALCAT --> TX["Proceed to<br>Treatment Pathway<br>(document 05)"]:::treat

Part 4 — Interpreting the CAC Score 

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    CACRESULT{CAC<br>Result?}

    CACRESULT -->|CAC = 0| P5[Continue to Part 5:<br>ApoB Check]:::link
    CACRESULT -->|CAC 1–99| UPINT[Reclassify<br>Upward]:::caution
    CACRESULT -->|CAC 100–299| HIGHMOD[High-Intensity<br>Statin]:::urgent
    CACRESULT -->|CAC ≥ 300| HIGHAGG[Aggressive<br>LDL-C Lowering<br>Per 2026 Guidelines]:::urgent

    UPINT --> FINALCAT[Assign Final<br>Risk Category]:::treat
    HIGHMOD --> FINALCAT
    HIGHAGG --> FINALCAT
    FINALCAT --> TX["Proceed to<br>Treatment Pathway<br>(document 05)"]:::treat

Part 5 — CAC = 0: De-Risking Check 

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    CAC0[CAC = 0]:::entry --> APOBCHECK{ApoB Below<br>Target?}

    APOBCHECK -->|Yes| DERISK[De-Risk:<br>Defer Statin<br>Lifestyle Focus]:::entry
    APOBCHECK -->|No| TREAT[ApoB Elevated:<br>Initiate Therapy<br>Despite CAC = 0]:::caution

    DERISK --> FOLLOWUP[Follow-Up<br>Per Protocol]:::admin
    TREAT --> FINALCAT[Assign Final<br>Risk Category]:::treat
    FINALCAT --> TX["Proceed to<br>Treatment Pathway<br>(document 05)"]:::treat

Part 6 — Confirming Low Risk 

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    LOW[Low Risk<br>PREVENT &lt; 3%]:::entry --> LPA2["Measure Lp(a)<br>if not done"]:::assess
    LPA2 --> LPARESULT{"Lp(a)<br>≥ 125 nmol/L?"}
    LPARESULT -->|Yes| ENH[Go to Part 3:<br>Evaluate Risk Enhancers]:::link
    LPARESULT -->|No| LOWFINAL[Confirmed Low Risk<br>Lifestyle Modification]:::entry
    LOWFINAL --> FOLLOWUP[Follow-Up<br>Per Protocol]:::admin

Key Decision Points

Node Clinical Document Reference
Established ASCVD check 04 — Risk Stratification, Section 2.0
PREVENT calculation 04 — Risk Stratification, Section 3.0
Risk enhancers 04 — Risk Stratification, Section 4.0
ApoB assessment 04 — Risk Stratification, Section 5.0
Lp(a) assessment 04 — Risk Stratification, Section 6.0
CAC scoring 04 — Risk Stratification, Section 7.0
De-risking (CAC=0 + ApoB negative) 04 — Risk Stratification, Section 7.4
FH evaluation 07 — FH Pathway

Version History

Version Date Description
1.0.0 2026-03-30 Initial release
1.1.0 2026-09-29 Split into smaller charts so text renders at full size; fixed line breaks that printed as literal escape codes; accessible color palette and shared legend

© 2026 The Sandusky Dyslipidemia Model. For clinical decision support only. Not a substitute for clinical judgment.