# Simon Broome definite FH

Simon Broome

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/simon_broome`
HTML: https://magentlab.com/docs/simon-broome
Markdown: https://magentlab.com/docs/simon-broome.md

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

## What it computes

Apply the 1991 Simon Broome Register adult definite familial hypercholesterolaemia rule and return definite or not_definite from one lipid value plus a caller-assigned tendon-xanthoma flag.

## When to use

When an agent already has adult total cholesterol or LDL cholesterol and a caller-assigned tendon-xanthoma flag (patient or listed relative) and needs the 1991 definite-register classification. magent does not assay lipids or examine tendons. Not possible FH and not a DNA-based classifier.

## When not to use

- Not a medical device and not a diagnosis of familial hypercholesterolaemia.
- magent does not assay lipids or examine tendons. The caller supplies exactly one lipid and the xanthoma flag.
- Adult definite FH as used for the 1991 register only. Does not classify possible FH, apply child cholesterol cutoffs (6.7 / 4.0 mmol/L), or use DNA mutation evidence.
- Tendon xanthomas in the patient or a relative (parent, child, grandparent, sibling, uncle, or aunt) are caller-assigned. magent does not take a pedigree.

## Formula

```
definite FH iff (total cholesterol >7.5 mmol/L or LDL cholesterol >4.9 mmol/L) and tendon xanthomas in the patient or a relative (parent, child, grandparent, sibling, uncle, or aunt); adult 1991 register definition
```

## Citation

[Risk of fatal coronary heart disease in familial hypercholesterolaemia](https://doi.org/10.1136/bmj.303.6807.893)
Scientific Steering Committee on behalf of the Simon Broome Register Group
BMJ. 1991;303(6807):893-896
DOI: [10.1136/bmj.303.6807.893](https://doi.org/10.1136/bmj.303.6807.893)

## Worked example

### Adult total cholesterol 8.0 mmol/L with tendon xanthomas is definite FH

Given: `tendon_xanthoma_patient_or_relative=true, total_cholesterol_mmol_l=8.0`

1. total_cholesterol_mmol_l 8.0 > 7.5 → cholesterol_threshold_met true
2. tendon_xanthoma_patient_or_relative true
3. both criteria met → classification definite


## Also searched as

- Simon Broome
- Simon Broome Register
- definite familial hypercholesterolaemia
- tendon xanthoma FH
- Simon Broome criteria
- familial hypercholesterolemia criteria
- adult definite FH cholesterol

## Parameters

- `total_cholesterol_mmol_l` (number, optional): Total cholesterol in mmol/L (1.3-20). Adult threshold is >7.5 mmol/L (7.5 does not meet). Provide exactly one of total_cholesterol_mmol_l, total_cholesterol_mg_dl, ldl_mmol_l, or ldl_mg_dl. magent does not assay lipids.
- `total_cholesterol_mg_dl` (number, optional): Total cholesterol in mg/dL (50-800). Converted to mmol/L as mg/dL / 38.67, then compared with >7.5. Provide exactly one lipid parameter.
- `ldl_mmol_l` (number, optional): LDL cholesterol in mmol/L (1-15). Adult threshold is >4.9 mmol/L (4.9 does not meet). Provide exactly one lipid parameter. magent does not assay lipids.
- `ldl_mg_dl` (number, optional): LDL cholesterol in mg/dL (40-600). Converted to mmol/L as mg/dL / 38.67, then compared with >4.9. Provide exactly one lipid parameter.
- `tendon_xanthoma_patient_or_relative` (boolean, required): Tendon xanthomas in the patient or a relative (parent, child, grandparent, sibling, uncle, or aunt) as assigned by the caller. true or false. magent does not examine tendons or take a pedigree.

## 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.

Method: `POST /api/calc/simon_broome`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: 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:

```json
{
  "items": [
    {
      "tendon_xanthoma_patient_or_relative": "true",
      "total_cholesterol_mmol_l": "8.0"
    },
    {
      "tendon_xanthoma_patient_or_relative": "true",
      "total_cholesterol_mmol_l": "8.0"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/simon-broome

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/simon_broome",
  "items": [
    {
      "components": [
        {
          "value": 8.0,
          "factor": "cholesterol_threshold",
          "met": true
        },
        {
          "factor": "tendon_xanthoma",
          "met": true
        }
      ],
      "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": "Scientific Steering Committee on behalf of the Simon Broome Register Group",
        "doi": "10.1136/bmj.303.6807.893",
        "id": "simon-broome-1991",
        "source": "BMJ. 1991;303(6807):893-896",
        "title": "Risk of fatal coronary heart disease in familial hypercholesterolaemia"
      },
      "formula": "simon_broome",
      "formula_expression": "definite FH iff (total cholesterol >7.5 mmol/L or LDL cholesterol >4.9 mmol/L) and tendon xanthomas in the patient or a relative (parent, child, grandparent, sibling, uncle, or aunt); adult 1991 register definition",
      "classification": "definite",
      "cholesterol_threshold_met": true,
      "lipid_kind": "total_cholesterol",
      "lipid_mmol_l": 8.0,
      "tendon_xanthoma_patient_or_relative": true
    },
    {
      "components": [
        {
          "value": 8.0,
          "factor": "cholesterol_threshold",
          "met": true
        },
        {
          "factor": "tendon_xanthoma",
          "met": true
        }
      ],
      "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": "Scientific Steering Committee on behalf of the Simon Broome Register Group",
        "doi": "10.1136/bmj.303.6807.893",
        "id": "simon-broome-1991",
        "source": "BMJ. 1991;303(6807):893-896",
        "title": "Risk of fatal coronary heart disease in familial hypercholesterolaemia"
      },
      "formula": "simon_broome",
      "formula_expression": "definite FH iff (total cholesterol >7.5 mmol/L or LDL cholesterol >4.9 mmol/L) and tendon xanthomas in the patient or a relative (parent, child, grandparent, sibling, uncle, or aunt); adult 1991 register definition",
      "classification": "definite",
      "cholesterol_threshold_met": true,
      "lipid_kind": "total_cholesterol",
      "lipid_mmol_l": 8.0,
      "tendon_xanthoma_patient_or_relative": true
    }
  ]
}
```

## Response fields

- `formula` (string): simon_broome
- `formula_expression` (string): Published 1991 adult definite-register rule
- `lipid_mmol_l` (number): The supplied lipid converted to mmol/L (mg/dL / 38.67 when a mg/dL key is used)
- `lipid_kind` (string): total_cholesterol or ldl, matching the supplied lipid key
- `cholesterol_threshold_met` (boolean): true when total cholesterol >7.5 mmol/L or LDL cholesterol >4.9 mmol/L. 7.5 and 4.9 do not meet.
- `tendon_xanthoma_patient_or_relative` (boolean): Echo of the caller-assigned xanthoma flag
- `classification` (string): definite when the lipid threshold and xanthoma flag both hold; otherwise not_definite. Not a diagnosis.
- `components` (array): Rows for cholesterol_threshold and tendon_xanthoma with factor, met, and value on the lipid row
- `citation` (object): Simon Broome Register BMJ 1991 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "value": 8.0,
      "factor": "cholesterol_threshold",
      "met": true
    },
    {
      "factor": "tendon_xanthoma",
      "met": true
    }
  ],
  "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": "Scientific Steering Committee on behalf of the Simon Broome Register Group",
    "doi": "10.1136/bmj.303.6807.893",
    "id": "simon-broome-1991",
    "source": "BMJ. 1991;303(6807):893-896",
    "title": "Risk of fatal coronary heart disease in familial hypercholesterolaemia"
  },
  "formula": "simon_broome",
  "formula_expression": "definite FH iff (total cholesterol >7.5 mmol/L or LDL cholesterol >4.9 mmol/L) and tendon xanthomas in the patient or a relative (parent, child, grandparent, sibling, uncle, or aunt); adult 1991 register definition",
  "classification": "definite",
  "cholesterol_threshold_met": true,
  "lipid_kind": "total_cholesterol",
  "lipid_mmol_l": 8.0,
  "tendon_xanthoma_patient_or_relative": true
}
```

## Errors

- HTTP 400 `invalid_simon_lipid`: provide exactly one of total_cholesterol_mmol_l (1.3-20), total_cholesterol_mg_dl (50-800), ldl_mmol_l (1-15), or ldl_mg_dl (40-600). Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Friedewald LDL-C](https://magentlab.com/docs/friedewald) — Estimate LDL-C from total cholesterol, HDL, and triglycerides using Friedewald 1972.
- [Sampson LDL-C](https://magentlab.com/docs/sampson) — Estimate LDL-C from total cholesterol, HDL, and triglycerides using Sampson 2020.

## 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.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/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.