Disclaimer: Clinical decision support for healthcare professionals only. It does not diagnose, prescribe, or replace local prescribing information, local guidelines, formulary/access criteria, patient consent, or clinical judgment. Records are saved only on this device — in the data folder you choose (or in this browser if folder access is unavailable); nothing is sent to any server. Do not enter directly identifiable patient information.
Risk category—
LDL-C goal—
Gap to goal—
WHO 2019 non-laboratory CVD risk chart — South Asia region (Bangladesh, Bhutan, India, Nepal, Pakistan). Estimates the 10-year risk of a fatal or non-fatal cardiovascular event in adults aged 40–74 without known ASCVD. This tool auto-calculates the risk directly from the official WHO South Asia non-laboratory chart (all 700 cell values transcribed from the WHO chart and validated) — enter the profile below and it returns the 10-year risk %, the WHO risk band, the ESC/EAS category, and the LDL-C target, and can send the result to the Patient tab. Source: WHO CVD Risk Chart Working Group / WHO PEN, non-laboratory South Asia chart (2019).
WHO risk profile
Record the profile used to look up the chart. Age is prefilled from the Patient tab when available.
Patient profile (WHO non-laboratory chart)
Includes those who quit <1 year ago.
Enter height and weight to compute BMI.
Optional override
Leave blank to auto-calculate from the chart. If entered, this value is used instead.
Optional data — quality improvement, service evaluation & research. Additional lipids, further Box 1 risk modifiers, and de-identified clinical data for case study / case series / observational use. These fields are saved together with the Patient assessment as one record when you press Save in the bar above. Do not enter directly identifiable patient information. Research use is subject to ethics-committee approval and the consent recorded on the Patient tab.
Optional lipids & risk modifiers
Additional lipids
Uses the ≥150 mg/dL (≥1.7 mmol/L) flag; recorded as mg/dL.
Non-HDL-C (secondary target)
—
Enter total cholesterol (Patient tab) and HDL-C to compute.
Further Box 1 risk modifiers (2025 ESC/EAS)
Advisory only — like the Box 1 modifiers on the Patient tab, these flag possible up-classification but do not change the calculated category.
Research / observational data (de-identified)
Demographics & lifestyle
Comorbidities
Baseline labs
Recorded for research; the Patient-tab Lp(a) tick drives the risk modifier.
Index event & follow-up
Other current medications (tick all that apply)
Statin, ezetimibe, bempedoic acid and PCSK9-targeted therapy are captured on the Patient tab.
Saved records
Assessments saved on this device. Open a record to review it or to add follow-up data on the Optional data tab, then press Save to update it.
Checking storage…
| Patient ID | Assessment date | Risk category | LDL-C | LDL-C goal | Gap | Follow-up date | Last saved |
|---|
No saved records yet. Complete an assessment and press Save.
How your data is stored
- Where: in the folder you choose on this laptop. The app creates
ASCVD_RWE_Datawith one file per assessment inrecords/, plusrwe_records.csv— a spreadsheet of all records that opens in Excel and is refreshed every time you save. - Nothing is uploaded. The app has no server connection; records stay on this device unless you copy or share the folder or an export.
- Each new session the browser asks you once to reconnect the folder — a browser security rule.
- Backups: keep the folder in a location approved by your IT / data-protection team (for example a company-managed OneDrive folder), or use Export backup regularly. If the laptop is lost, records that were not backed up are lost too.
- Browsers: folder saving works in Google Chrome and Microsoft Edge on laptops and desktops. Other browsers save inside the browser instead — export regularly and do not clear browsing data.
- Privacy: enter de-identified data only (an anonymous patient code — never a name, CNIC, MRN or phone number). Use an encrypted laptop (e.g. BitLocker) and do not share your login.
Risk logic & references
Automatic rule-based approach for HCP decision support, aligned to the 2019 ESC/EAS guidelines and the 2025 focused update.
Risk modifiers (Box 1, 2025 ESC/EAS)
- Box 1 lists factors that may support reclassifying an individual to a higher risk category than the calculated (WHO/local) risk estimate — particularly for those around treatment-decision thresholds: family history of premature CVD (M <55, W <60), high-risk ethnicity (e.g. South Asian), obesity, physical inactivity, psychosocial stress, social deprivation, chronic immune-mediated/inflammatory disorders, major psychiatric disorders, premature menopause, pre-eclampsia/hypertensive disorders of pregnancy, HIV, obstructive sleep apnoea, and persistently elevated hs-CRP (>2 mg/L). Elevated Lp(a) >50 mg/dL (>105 nmol/L) is also a Box 1 modifier and is captured in the Lp(a) field.
- The tool treats these as advisory only: selecting them does not change the calculated risk category or LDL-C target. Instead it flags whether up-classification to the next category may be reasonable to consider — with added emphasis when the 10-year risk sits in the upper part of its band (near a threshold). Reclassification remains a clinical judgment.
Automatic risk categories
- Extreme risk (2025 update): ASCVD with recurrent vascular event(s) while on maximally tolerated statin-based therapy, or polyvascular (e.g. coronary and peripheral) arterial disease. LDL-C goal <40 mg/dL (<1.0 mmol/L, Class IIb).
- Very high risk: documented ASCVD — which includes prior ACS/MI, chronic coronary syndromes, coronary or other revascularisation, stroke/TIA, peripheral arterial disease, or premature/early-onset ASCVD; severe or end-stage CKD; diabetes with target-organ damage, ≥3 major risk factors, or T1DM >20 years; FH with ASCVD or another major risk factor; or a WHO/local 10-year CVD risk in the very-high band.
- High risk: markedly elevated single factors — LDL-C >190 mg/dL (>4.9 mmol/L), total cholesterol >310 mg/dL (>8 mmol/L), or BP ≥180/110 mmHg; FH without another major risk factor; moderate CKD; diabetes ≥10 years or one major additional risk factor; or a WHO/local 10-year CVD risk in the high band. (Elevated Lp(a) is a risk modifier — see Box 1 — not a high-risk category by itself.)
- Moderate / Low risk: a WHO/local 10-year CVD risk in the moderate/low band, or no major criteria.
Key definitions
- Polyvascular disease: atherosclerotic disease involving ≥2 major arterial territories (e.g. coronary + peripheral arterial + cerebrovascular). In the 2025 ESC/EAS update this defines the extreme-risk category (LDL-C goal <40 mg/dL / <1.0 mmol/L).
- Multivessel coronary disease: significant atherosclerosis (typically >50% stenosis) in ≥2 major epicardial coronary arteries (LAD, LCx, RCA). It is documented ASCVD (at least very-high risk) but, confined to the coronary territory, is not by itself the guideline’s polyvascular / extreme-risk criterion unless a second, non-coronary territory is also involved.
WHO / local risk thresholds
- WHO / local CVD risk (South Asia): the 10-year CVD risk % is auto-calculated in the WHO / Local CVD Risk (Pakistan) tab and mapped to categories: very high ≥30%, high 20–<30%, moderate 10–<20%, low <10%. Applies to adults 40–74 without established ASCVD.
LDL-C and non-HDL-C targets
- Extremely high: LDL-C <40 mg/dL · non-HDL-C <70 mg/dL
- Very high: LDL-C <55 mg/dL and ≥50% reduction from baseline · non-HDL-C <85 mg/dL
- High: LDL-C <70 mg/dL and ≥50% reduction from baseline · non-HDL-C <100 mg/dL
- Moderate: LDL-C <100 mg/dL · non-HDL-C <130 mg/dL
- Low: LDL-C <116 mg/dL · non-HDL-C <146 mg/dL
- Target attainment requires the absolute goal and, where applicable, a ≥50% reduction from (ideally untreated) baseline. Non-HDL-C targets are secondary and matter most with high triglycerides.
Patient-prioritization score
- Extremely high risk +4 · Very high risk +3
- LDL-C above target despite high-intensity/max statin ± ezetimibe/bempedoic acid +3
- Partial/complete statin intolerance or contraindication +2 · FH / LDL-C ≥190 mg/dL +2
- Adherence or access/affordability concern +1 · Very high Lp(a) or premature ASCVD +1
Treatment & escalation logic
- At/below target: continue therapy, reinforce lifestyle/risk-factor control, monitor LDL-C and non-HDL-C.
- Not on statin (no contraindication): initiate high-intensity/maximally tolerated statin; in very-high/extreme risk with a large gap, consider upfront combination with ezetimibe ("strike early and strong").
- Low/moderate statin: intensify; add ezetimibe ± bempedoic acid if still above target.
- Statin intolerance/contraindication: oral non-statin pathway (ezetimibe and/or bempedoic acid); escalate to PCSK9-targeted therapy in high-risk or above where LDL-C remains above target.
- High/max statin still above target: add/document ezetimibe (± bempedoic acid); if still above target or oral options unsuitable, escalate to PCSK9-targeted therapy.
- Escalation options are shown as a class (PCSK9-targeted therapy = PCSK9 monoclonal antibody or inclisiran). Agent selection depends on formulary/access criteria, administration fit, and HCP judgment.
Positioning & governance
- This tool presents class-based guidance. The inclisiran line is decision support only and is access-gated; it is not a promotional recommendation.
- Confirm formulary/patient-access criteria and affordability before any escalation.
References
- 2019 ESC/EAS Guidelines for the management of dyslipidaemias (Eur Heart J. 2020;41:111–188).
- 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias (Mach F, et al. Eur Heart J. 2025; Atherosclerosis. 2025;409:120479).
- Local prescribing information and local clinical guidelines should prevail.