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Very high-risk ASCVD (AHA/ACC 2018)

Apply AHA/ACC 2018 Table 4 and return whether known clinical ASCVD is very high-risk from caller-assigned major events and high-risk conditions.

LIVE $0.005 USDC GET /api/calc/ascvd_vhr

Markdown: /docs/ascvd-vhr.md · Canonical: https://magentlab.com/docs/ascvd-vhr

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

Apply AHA/ACC 2018 Table 4 and return whether known clinical ASCVD is very high-risk from caller-assigned major events and high-risk conditions.

When to use

When an agent already has known clinical ASCVD and needs the 2018 AHA/ACC Table 4 very-high-risk classifier, and must not use the 2013 PCE, SCORE2, or a statin, ezetimibe, or PCSK9 order.

When not to use

Not a medical device. Not a prescription. magent does not diagnose ASCVD or measure ABI or LDL-C.
Not a statin, ezetimibe, or PCSK9 order. Does not apply Figure 1 LDL-C ≥70 mg/dL treatment thresholds. Does not compute PCE 10-year risk (that is ascvd-pce).
Very high-risk iff ≥2 major ASCVD events or 1 major event and ≥2 high-risk conditions (Table 4 “multiple”). Zero major events is not very high-risk even with many conditions.
CKD is the printed eGFR 15–59 mL/min/1.73 m² band as a caller-assigned flag. Flags are caller-supplied. magent does not compute eGFR, assay LDL-C, or measure ABI.

Formula

very_high_risk iff major_event_count ≥ 2 or (major_event_count = 1 and high_risk_condition_count ≥ 2) (AHA/ACC 2018 Table 4 / Figure 1). Major events (caller-assigned): recent ACS within 12 months; history of MI other than that recent ACS; history of ischemic stroke; symptomatic PAD (claudication with ABI <0.85, or prior revascularization or amputation). High-risk conditions: age ≥65 years; heterozygous familial hypercholesterolemia; prior CABG or PCI outside the major ASCVD event(s); diabetes mellitus; hypertension; CKD (eGFR 15–59 mL/min/1.73 m²); current smoking; persistently elevated LDL-C ≥100 mg/dL (≥2.6 mmol/L) despite maximally tolerated statin and ezetimibe; history of congestive HF. Not PCE 10-year risk. Not a statin, ezetimibe, or PCSK9 order. magent does not diagnose ASCVD or measure ABI or LDL-C

Citation

Title: 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol
Authors: Grundy SM, Stone NJ, Bailey AL, et al.
Source: Circulation. 2019;139(25):e1082-e1143
DOI: 10.1161/CIR.0000000000000625

Worked example

Prior MI, age ≥65, and diabetes

Given: age=70ckd_egfr_15_to_59=falsecongestive_hf=falsecurrent_smoking=falsediabetes=trueheterozygous_fh=falsehistory_mi=truehypertension=falseischemic_stroke=falseldl_c_ge_100_on_max_statin_ezetimibe=falseprior_cabg_or_pci_outside_major=falserecent_acs=falsesymptomatic_pad=false

history_mi is one major event; recent ACS, ischemic stroke, and symptomatic PAD are false
age 70 ≥ 65 and diabetes are two high-risk conditions
1 major event and ≥2 high-risk conditions is very high-risk

Prior MI and only hypertension

Given: age=50ckd_egfr_15_to_59=falsecongestive_hf=falsecurrent_smoking=falsediabetes=falseheterozygous_fh=falsehistory_mi=truehypertension=trueischemic_stroke=falseldl_c_ge_100_on_max_statin_ezetimibe=falseprior_cabg_or_pci_outside_major=falserecent_acs=falsesymptomatic_pad=false

history_mi is one major event
age 50 is not ≥65; hypertension is the only high-risk condition
1 major event and 1 high-risk condition is not very high-risk

Also searched as

very high-risk ASCVD
AHA ACC 2018 Table 4
known ASCVD very high risk
Grundy 2018 cholesterol
clinical ASCVD very high-risk
secondary prevention very high-risk
AHA ACC cholesterol guideline

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/ascvd_vhr?age=70&recent_acs=false&history_mi=true&ischemic_stroke=false&symptomatic_pad=false&heterozygous_fh=false&prior_cabg_or_pci_outside_major=false&diabetes=true&hypertension=false&ckd_egfr_15_to_59=false&current_smoking=false&ldl_c_ge_100_on_max_statin_ezetimibe=false&congestive_hf=false

Full URL: https://api.magentlab.com/api/calc/ascvd_vhr?age=70&recent_acs=false&history_mi=true&ischemic_stroke=false&symptomatic_pad=false&heterozygous_fh=false&prior_cabg_or_pci_outside_major=false&diabetes=true&hypertension=false&ckd_egfr_15_to_59=false&current_smoking=false&ldl_c_ge_100_on_max_statin_ezetimibe=false&congestive_hf=false

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/ascvd_vhr?age=70&recent_acs=false&history_mi=true&ischemic_stroke=false&symptomatic_pad=false&heterozygous_fh=false&prior_cabg_or_pci_outside_major=false&diabetes=true&hypertension=false&ckd_egfr_15_to_59=false&current_smoking=false&ldl_c_ge_100_on_max_statin_ezetimibe=false&congestive_hf=false"

Parameters

Name	Type	Required	Description
`age`	integer	required	Age in years (18-120). ≥65 is an AHA/ACC 2018 Table 4 high-risk condition. magent does not assign age.
`recent_acs`	boolean	required	Recent ACS within the past 12 months as assigned by the caller (AHA/ACC 2018 Table 4 major ASCVD event). true or false. magent does not date ACS.
`history_mi`	boolean	required	History of MI other than a caller-assigned recent ACS as assigned by the caller (AHA/ACC 2018 Table 4 major ASCVD event). true or false. magent does not diagnose MI.
`ischemic_stroke`	boolean	required	History of ischemic stroke as assigned by the caller (AHA/ACC 2018 Table 4 major ASCVD event). true or false. magent does not diagnose stroke.
`symptomatic_pad`	boolean	required	Symptomatic PAD as assigned by the caller from the Table 4 row (claudication with ABI <0.85, or previous revascularization or amputation). true or false. magent does not measure ABI.
`heterozygous_fh`	boolean	required	Heterozygous familial hypercholesterolemia as assigned by the caller (AHA/ACC 2018 Table 4 high-risk condition). true or false. magent does not diagnose FH.
`prior_cabg_or_pci_outside_major`	boolean	required	Prior CABG or PCI outside the major ASCVD event(s) as assigned by the caller (AHA/ACC 2018 Table 4 high-risk condition). true or false. magent does not read an operative note.
`diabetes`	boolean	required	Diabetes mellitus as assigned by the caller (AHA/ACC 2018 Table 4 high-risk condition). true or false. magent does not diagnose diabetes.
`hypertension`	boolean	required	Hypertension as assigned by the caller (AHA/ACC 2018 Table 4 high-risk condition). true or false. magent does not measure blood pressure.
`ckd_egfr_15_to_59`	boolean	required	CKD with eGFR 15–59 mL/min/1.73 m² as assigned by the caller (AHA/ACC 2018 Table 4 printed band). true or false. magent does not compute eGFR.
`current_smoking`	boolean	required	Current smoking as assigned by the caller (AHA/ACC 2018 Table 4 high-risk condition). true or false. magent does not assign smoking status.
`ldl_c_ge_100_on_max_statin_ezetimibe`	boolean	required	Persistently elevated LDL-C ≥100 mg/dL (≥2.6 mmol/L) despite maximally tolerated statin and ezetimibe as assigned by the caller (AHA/ACC 2018 Table 4 high-risk condition). true or false. magent does not assay LDL-C.
`congestive_hf`	boolean	required	History of congestive HF as assigned by the caller (AHA/ACC 2018 Table 4 high-risk condition). true or false. magent does not diagnose HF.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/ascvd_vhr Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "age": "70",
      "ckd_egfr_15_to_59": "false",
      "congestive_hf": "false",
      "current_smoking": "false",
      "diabetes": "true",
      "heterozygous_fh": "false",
      "history_mi": "true",
      "hypertension": "false",
      "ischemic_stroke": "false",
      "ldl_c_ge_100_on_max_statin_ezetimibe": "false",
      "prior_cabg_or_pci_outside_major": "false",
      "recent_acs": "false",
      "symptomatic_pad": "false"
    },
    {
      "age": "70",
      "ckd_egfr_15_to_59": "false",
      "congestive_hf": "false",
      "current_smoking": "false",
      "diabetes": "true",
      "heterozygous_fh": "false",
      "history_mi": "true",
      "hypertension": "false",
      "ischemic_stroke": "false",
      "ldl_c_ge_100_on_max_statin_ezetimibe": "false",
      "prior_cabg_or_pci_outside_major": "false",
      "recent_acs": "false",
      "symptomatic_pad": "false"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/ascvd_vhr",
  "items": [
    {
      "age": 70,
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Grundy SM, Stone NJ, Bailey AL, et al.",
        "doi": "10.1161/CIR.0000000000000625",
        "id": "grundy-2018-aha-acc-cholesterol",
        "pmid": "30586774",
        "source": "Circulation. 2019;139(25):e1082-e1143",
        "title": "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol"
      },
      "formula": "ascvd_vhr",
      "formula_expression": "very_high_risk iff major_event_count ≥ 2 or (major_event_count = 1 and high_risk_condition_count ≥ 2) (AHA/ACC 2018 Table 4 / Figure 1). Major events (caller-assigned): recent ACS within 12 months; history of MI other than that recent ACS; history of ischemic stroke; symptomatic PAD (claudication with ABI <0.85, or prior revascularization or amputation). High-risk conditions: age ≥65 years; heterozygous familial hypercholesterolemia; prior CABG or PCI outside the major ASCVD event(s); diabetes mellitus; hypertension; CKD (eGFR 15–59 mL/min/1.73 m²); current smoking; persistently elevated LDL-C ≥100 mg/dL (≥2.6 mmol/L) despite maximally tolerated statin and ezetimibe; history of congestive HF. Not PCE 10-year risk. Not a statin, ezetimibe, or PCSK9 order. magent does not diagnose ASCVD or measure ABI or LDL-C",
      "criteria": [
        {
          "factor": "recent_acs",
          "met": false
        },
        {
          "factor": "history_mi",
          "met": true
        },
        {
          "factor": "ischemic_stroke",
          "met": false
        },
        {
          "factor": "symptomatic_pad",
          "met": false
        },
        {
          "value": 70,
          "factor": "age_ge_65",
          "met": true
        },
        {
          "factor": "heterozygous_fh",
          "met": false
        },
        {
          "factor": "prior_cabg_or_pci_outside_major",
          "met": false
        },
        {
          "factor": "diabetes",
          "met": true
        },
        {
          "factor": "hypertension",
          "met": false
        },
        {
          "factor": "ckd_egfr_15_to_59",
          "met": false
        },
        {
          "factor": "current_smoking",
          "met": false
        },
        {
          "factor": "ldl_c_ge_100_on_max_statin_ezetimibe",
          "met": false
        },
        {
          "factor": "congestive_hf",
          "met": false
        }
      ],
      "classifying_rule": "one_major_and_multiple_high_risk_conditions",
      "high_risk_condition_count": 2,
      "major_event_count": 1,
      "very_high_risk": true
    },
    {
      "age": 70,
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Grundy SM, Stone NJ, Bailey AL, et al.",
        "doi": "10.1161/CIR.0000000000000625",
        "id": "grundy-2018-aha-acc-cholesterol",
        "pmid": "30586774",
        "source": "Circulation. 2019;139(25):e1082-e1143",
        "title": "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol"
      },
      "formula": "ascvd_vhr",
      "formula_expression": "very_high_risk iff major_event_count ≥ 2 or (major_event_count = 1 and high_risk_condition_count ≥ 2) (AHA/ACC 2018 Table 4 / Figure 1). Major events (caller-assigned): recent ACS within 12 months; history of MI other than that recent ACS; history of ischemic stroke; symptomatic PAD (claudication with ABI <0.85, or prior revascularization or amputation). High-risk conditions: age ≥65 years; heterozygous familial hypercholesterolemia; prior CABG or PCI outside the major ASCVD event(s); diabetes mellitus; hypertension; CKD (eGFR 15–59 mL/min/1.73 m²); current smoking; persistently elevated LDL-C ≥100 mg/dL (≥2.6 mmol/L) despite maximally tolerated statin and ezetimibe; history of congestive HF. Not PCE 10-year risk. Not a statin, ezetimibe, or PCSK9 order. magent does not diagnose ASCVD or measure ABI or LDL-C",
      "criteria": [
        {
          "factor": "recent_acs",
          "met": false
        },
        {
          "factor": "history_mi",
          "met": true
        },
        {
          "factor": "ischemic_stroke",
          "met": false
        },
        {
          "factor": "symptomatic_pad",
          "met": false
        },
        {
          "value": 70,
          "factor": "age_ge_65",
          "met": true
        },
        {
          "factor": "heterozygous_fh",
          "met": false
        },
        {
          "factor": "prior_cabg_or_pci_outside_major",
          "met": false
        },
        {
          "factor": "diabetes",
          "met": true
        },
        {
          "factor": "hypertension",
          "met": false
        },
        {
          "factor": "ckd_egfr_15_to_59",
          "met": false
        },
        {
          "factor": "current_smoking",
          "met": false
        },
        {
          "factor": "ldl_c_ge_100_on_max_statin_ezetimibe",
          "met": false
        },
        {
          "factor": "congestive_hf",
          "met": false
        }
      ],
      "classifying_rule": "one_major_and_multiple_high_risk_conditions",
      "high_risk_condition_count": 2,
      "major_event_count": 1,
      "very_high_risk": true
    }
  ]
}

Response

Field	Type	Description
`formula`	string	ascvd_vhr
`formula_expression`	string	AHA/ACC 2018 Table 4 very high-risk classifier
`age`	integer	Age in years used for the ≥65 condition
`very_high_risk`	boolean	true iff ≥2 major events or exactly 1 major event and ≥2 high-risk conditions. Not a treatment order.
`major_event_count`	integer	Count of the four Table 4 major ASCVD events that are true
`high_risk_condition_count`	integer	Count of Table 4 high-risk conditions, including age ≥65 when met. Still reported when ≥2 majors already classify.
`classifying_rule`	string	two_or_more_major_events, one_major_and_multiple_high_risk_conditions, or not_very_high_risk
`criteria`	array	Per-factor rows for the four major events, age_ge_65 (with age value), and eight high-risk flags
`citation`	object	Grundy 2018 Circulation citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "age": 70,
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Grundy SM, Stone NJ, Bailey AL, et al.",
    "doi": "10.1161/CIR.0000000000000625",
    "id": "grundy-2018-aha-acc-cholesterol",
    "pmid": "30586774",
    "source": "Circulation. 2019;139(25):e1082-e1143",
    "title": "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol"
  },
  "formula": "ascvd_vhr",
  "formula_expression": "very_high_risk iff major_event_count ≥ 2 or (major_event_count = 1 and high_risk_condition_count ≥ 2) (AHA/ACC 2018 Table 4 / Figure 1). Major events (caller-assigned): recent ACS within 12 months; history of MI other than that recent ACS; history of ischemic stroke; symptomatic PAD (claudication with ABI <0.85, or prior revascularization or amputation). High-risk conditions: age ≥65 years; heterozygous familial hypercholesterolemia; prior CABG or PCI outside the major ASCVD event(s); diabetes mellitus; hypertension; CKD (eGFR 15–59 mL/min/1.73 m²); current smoking; persistently elevated LDL-C ≥100 mg/dL (≥2.6 mmol/L) despite maximally tolerated statin and ezetimibe; history of congestive HF. Not PCE 10-year risk. Not a statin, ezetimibe, or PCSK9 order. magent does not diagnose ASCVD or measure ABI or LDL-C",
  "criteria": [
    {
      "factor": "recent_acs",
      "met": false
    },
    {
      "factor": "history_mi",
      "met": true
    },
    {
      "factor": "ischemic_stroke",
      "met": false
    },
    {
      "factor": "symptomatic_pad",
      "met": false
    },
    {
      "value": 70,
      "factor": "age_ge_65",
      "met": true
    },
    {
      "factor": "heterozygous_fh",
      "met": false
    },
    {
      "factor": "prior_cabg_or_pci_outside_major",
      "met": false
    },
    {
      "factor": "diabetes",
      "met": true
    },
    {
      "factor": "hypertension",
      "met": false
    },
    {
      "factor": "ckd_egfr_15_to_59",
      "met": false
    },
    {
      "factor": "current_smoking",
      "met": false
    },
    {
      "factor": "ldl_c_ge_100_on_max_statin_ezetimibe",
      "met": false
    },
    {
      "factor": "congestive_hf",
      "met": false
    }
  ],
  "classifying_rule": "one_major_and_multiple_high_risk_conditions",
  "high_risk_condition_count": 2,
  "major_event_count": 1,
  "very_high_risk": true
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_ascvd_vhr`	Very high-risk ASCVD inputs must match AHA/ACC 2018 major ASCVD events and high-risk conditions. Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

2013 PCE 10-year ASCVD — Compute the Goff 2013 pooled-cohort 10-year hard ASCVD percent (first hard CHD or stroke) for adults aged 40-79 from Table A sex- and cohort-specific coefficients.
SCORE2 10-year CVD risk — Compute the ESC 2021 SCORE2 10-year fatal plus non-fatal CVD percent for adults aged 40-69 from sex, current smoking, systolic blood pressure, non-HDL cholesterol, and European geographic risk region.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.