👤 Patient Demographics & Basic Information

Enter patient data for cardiovascular risk assessment

Patient ID: Not Generated

📋 Basic Information

Patient Name (Optional)

Assessment Date

Age (years) Framingham: 30-79 | QRISK: 25-84

Biological Sex

Ethnicity Used for QRISK3/4 calculations

📏 Anthropometric Measurements

Height

Weight

Waist Circumference

Measure at umbilicus level

Hip Circumference

⚠️ Required for BRI calculation

BMI

kg/m²

BRI (Body Roundness)
--
index

Waist/Hip Ratio

ratio

BSA

m²

❓ Why BRI over BMI?

Body Roundness Index (BRI) predicts central adiposity better than BMI. Studies show BRI correlates more strongly with cardiometabolic risk, visceral fat, and mortality. Thomas DM et al., Obesity 2013;21:E338-42.

Formula: BRI = 364.2 - 365.5 × √(1 - ((WC / 2π)² / (0.5 × height)²))

🩺 Blood Pressure

Systolic BP (mmHg)

Diastolic BP (mmHg)

Heart Rate (bpm)

BP Treatment Status

⚠️ Risk Factors

Current Smoker Diabetes Family History CVD (<60y) Prior MI Prior Stroke/TIA Other Prior CVD CKD Stage 3+ Atrial Fibrillation

💊 Medications & Laboratory Values

Enter current medications and lab results

🧪 Lipid Panel v

Total Cholesterol

LDL Cholesterol

HDL Cholesterol

Triglycerides

🧬 Lipoprotein(a)

⚠️ Elevated ≥50 mg/dL or ≥125 nmol/L

🔬 Apolipoprotein B

Target: <90 mg/dL (high risk: <65)

Non-HDL

mg/dL

TC/HDL Ratio

LDL (Friedewald)

TC - HDL - TG/5

LDL (Martin/Hopkins)

More accurate for TG <400

📊 LDL Calculation Methods:

Friedewald (1972): LDL = TC - HDL - TG/5 (mg/dL). Invalid if TG >400 mg/dL
Martin/Hopkins (2013): Uses adjustable factor based on TG and non-HDL levels. More accurate for TG 100-400 mg/dL. Reference: JAMA 2013

🔬 Biomarker Quick Reference:

Lp(a): Genetically determined (~90%), independent CVD risk factor. 1 in 5 people have elevated levels. Not lowered by statins. Screen once in lifetime + cascade family screening if elevated.

ApoB-100: One molecule per atherogenic particle (LDL, VLDL, Lp(a)). Better predictor than LDL-C, especially with high TG or metabolic syndrome. Reflects total atherogenic particle count.

🫁 Liver Panel, FIB-4 & NAFLD v

AST (U/L)

ALT (U/L)

Platelets (×10⁹/L)Required for FIB-4 & NFS

Albumin (g/dL)Required for NAFLD-FS

GGT (U/L)Optional

ALP (U/L)Optional

Diabetes/IFG Status For NAFLD Fibrosis Score

FIB-4 Score

Liver fibrosis

AST/ALT Ratio

NAFLD Fibrosis Score

Advanced fibrosis risk

APRI Score

Fibrosis/cirrhosis

Liver Fibrosis Score Interpretation

Score	Low Risk	Indeterminate	High Risk
FIB-4	<1.30	1.30-2.67	>2.67
NAFLD-FS	<-1.455	-1.455 to 0.676	>0.676
APRI	<0.5	0.5-1.5	>1.5

References: FIB-4 (Sterling 2006), NAFLD-FS (Angulo 2007), APRI (Wai 2003)

🔬 Enhanced Liver Fibrosis (ELF) Score v

About ELF Score: Uses direct serum markers of liver fibrosis (HA, PIIINP, TIMP-1) for accurate staging. More accurate than indirect scores but requires specialized testing.

Hyaluronic Acid (HA)

ng/mL

Normal: <75 ng/mL

PIIINP (Procollagen III N-terminal Peptide)

ng/mL

Normal: 3-15 ng/mL

TIMP-1 (Tissue Inhibitor of Metalloproteinase-1)

ng/mL

Normal: 150-250 ng/mL

ELF Score

Direct fibrosis markers

ELF Interpretation:
• <7.7: No/mild fibrosis (F0-F1)
• 7.7-9.8: Moderate fibrosis (F2-F3)
• ≥9.8: Advanced fibrosis/cirrhosis (F3-F4)

🔗 CKD-FIB4 Cardiometabolic Interaction v

About CKD-FIB4 Interaction: Combined kidney and liver assessment for cardiometabolic risk. Patients with both CKD and elevated FIB-4 have significantly higher cardiovascular and all-cause mortality than either condition alone.

eGFR Status

CKD Stage

FIB-4 Status

Fibrosis Risk

Combined Cardiometabolic Risk

Liver-Kidney interaction

Risk Stratification:
• Low: eGFR ≥60 AND FIB-4 <1.30 (HR 1.0 reference)
• Moderate: eGFR <60 OR FIB-4 ≥1.30 (HR ~1.5-2.0)
• High: eGFR <60 AND FIB-4 ≥1.30 (HR ~2.5-3.5)
• Very High: eGFR <45 AND FIB-4 ≥2.67 (HR ~4.0+)

🫘 Kidney Panel & eGFR v

Creatinine

UACR (Urine Albumin-to-Creatinine Ratio)

A1: <30 | A2: 30-300 | A3: >300 mg/g

eGFR Method

eGFR

mL/min/1.73m²

CKD Stage

🩸 CBC & ANC Calculator (Enhanced) v

WBC Count

Hemoglobin (g/dL)

Hematocrit (%)

Platelets (×10⁹/L)

🔬 Comprehensive ANC Calculator (Marrowforums Reference)

Input Format

Segmented Neutrophils %

Band Neutrophils %

Metamyelocytes %

Myelocytes %

Promyelocytes %

Blasts % ⚠️ Blasts >0% requires urgent hematology review

💡 Tip: Include ALL immature forms for accurate ANC in bone marrow disorders. Bands >10% indicates left shift (infection/stress).

ANC

cells/μL

Interpretation

Neutropenia Grade

Total Immatures %

📖 ANC Reference (marrowforums.org)

Formula: ANC = WBC × (Segs + Bands + Metas + Myelos + Promyelos) / 100 × 1000

<500	Severe neutropenia (Grade 4)	High infection risk
500-999	Moderate neutropenia (Grade 3)	Significant risk
1000-1499	Mild neutropenia (Grade 2)	Moderate risk
1500-8000	Normal range	Low risk
>8000	Neutrophilia	Investigate cause

🍬 Diabetes Panel & HOMA v

Fasting Glucose

HbA1c (%)

Fasting Insulin (μU/mL)

HOMA-IR

Insulin resistance

Est. Average Glucose

mg/dL

HOMA-IR Interpretation

<1.0: Normal sensitivity | 1.0-1.9: Early resistance | 2.0-2.9: Significant resistance | ≥3.0: Severe resistance

Formula: (Fasting Insulin × Fasting Glucose) / 405

Reference: Matthews DR et al. Diabetologia 1985. DOI: 10.1007/BF00280883

🔥 Inflammation Panel v

hs-CRP (mg/L) <1 low risk, 1-3 moderate, >3 high risk

ESR (mm/hr)

Ferritin (ng/mL)

Homocysteine (μmol/L) >15 μmol/L associated with increased CVD risk

🦋 Thyroid Function v

TSH (mIU/L) Normal: 0.4-4.0 mIU/L

Free T4 (pmol/L) Normal: 9-25 pmol/L

Free T3 (pmol/L) Normal: 3-7 pmol/L

ℹ Clinical Note: Thyroid dysfunction affects cardiovascular risk. Hypothyroidism increases LDL and CVD risk. Hyperthyroidism can cause arrhythmias and heart failure.

🧬 Hormones, Vitamins & Nuclear Receptor Ligands v

Compounds that cross cell membranes and bind to cytosolic or nuclear receptors

Vitamin D (25-OH)

Deficient: <50 nmol/L (<20 ng/mL)

Testosterone

Estradiol (pmol/L)

Cortisol AM (nmol/L) Normal AM: 140-690 nmol/L

DHEA-S (μmol/L)

Progesterone (nmol/L)

IGF-1 (ng/mL)

SHBG (nmol/L)

🔬 Mechanism: These lipophilic compounds cross cell membranes and bind to intracellular receptors (nuclear hormone receptors), regulating gene transcription. They affect cardiovascular risk through multiple pathways including lipid metabolism, inflammation, and vascular function.

💊 Current Medications

Medication Name	Dose	Frequency	Start Date	Duration (months)	Status	LDL Reduction %	Actions

Active Medications

Expected LDL Reduction

PCSK9 Eligibility

Interactions Found

💊 Lipid-Lowering Drug Interaction Checker

This checker screens for common cardiovascular drug interactions including:

Statin + Fibrate: Increased myopathy risk (use fenofibrate over gemfibrozil)
Statin + CYP3A4 inhibitors: Avoid simvastatin with macrolides, azoles
PCSK9i + Statin: Synergistic effect (no interaction concern)
Ezetimibe + Cyclosporine: Increased ezetimibe exposure
Anticoagulants + NSAIDs: Increased bleeding risk

Note: Always verify interactions with clinical pharmacy resources.

📓 Related References: 💉 Lipid Science 🧬 Lp(a) Science 🫁 Liver/FIB-4 🫘 Kidney/eGFR 🔬 Metabolic 🩸 Hematology

📊 Framingham Risk Score Calculator

10-Year CVD Risk (D'Agostino et al., Circulation 2008)

📋 Risk Factor Inputs (9 Required)

Enter values here OR they will auto-populate from Patient & Labs tabs if filled there.

Age (30-79)Valid: 30-79 years

Biological Sex

Total Cholesterol (mg/dL)

HDL Cholesterol (mg/dL)

Systolic BP (mmHg)

BP Treatment

Current Smoker

Diabetes

🔄 Auto-Sync: If you've entered data in the Patient & Labs tabs, click "Sync from Patient Tab" to pull those values here.

🧬 Lipoprotein(a) - Lp(a) Integration v

Lp(a) Value

Unit

Calculated Risk Modifier Format: 1.5× (auto-calculated from value above or manually select)

Note: Lp(a) is not part of the original Framingham equation but is applied as a risk multiplier based on current evidence (EAS 2022 consensus).

Age Pts	TC Pts	HDL Pts	SBP Pts	Smoking	Diabetes	Total Pts	Base Risk %	Modified Risk %
--	--	--	--	--	--	--	--	--

📛 Reference

Citation: D'Agostino RB et al. Circulation 2008;117:743-53. DOI: 10.1161/CIRCULATIONAHA.107.699579

Risk Categories: Low (<10%), Intermediate (10-19%), High (≥20%)

Validation: framinghamheartstudy.org

📓 Related References: ❤ CVD Risk Calculators 🧬 Lp(a) Science 📋 Clinical Guidelines 🔧 Validation Tools

🇬🇧 QRISK3/QRISK4 Calculator

UK-validated CVD risk with ethnicity, deprivation, and 14+ conditions

⚠️ Important Calculation Notice:

This toolkit uses a simplified approximation of the QRISK3/4 algorithms for educational purposes. For clinical decision-making, please validate results using the official calculator at qrisk.org.

The official QRISK3 algorithm uses complex fractional polynomials and sex-specific interaction terms that cannot be fully replicated without licensing from ClinRisk Ltd.

🔬 Understanding QRISK3 vs QRISK4

QRISK3 (2017)

Based on 10+ million UK patient records
9 ethnicity categories with specific coefficients
14 clinical conditions (RA, SLE, CKD, AF, etc.)
Townsend deprivation score integration
Validated in multiple UK populations

QRISK4 (2024) - New Features

BP Variability: SBP standard deviation from 6+ readings
Long COVID: Post-COVID cardiovascular effects
Air Pollution: Environmental exposure factor
Enhanced calibration for contemporary populations
Better discrimination in younger patients

💡 Tip: Use QRISK3 for standard assessments. Use QRISK4 when you have multiple BP readings, or for patients with Long COVID or high pollution exposure. Both scores are calculated simultaneously for comparison.

👤 Demographicsv

Age (25-84)

Biological Sex

Ethnicity (9 categories)

Townsend Deprivation Score (Optional) Range: -8 (affluent) to +12 (deprived)

ℹ️ About Townsend Score:
The Townsend Deprivation Index is a UK-specific measure of socioeconomic status based on:
• Unemployment rate
• Non-car ownership
• Non-home ownership
• Household overcrowding

How to determine: In the UK, look up your postcode at ukpostcode.co.uk or similar services. For non-UK users, leave at 0 (average) or estimate based on local socioeconomic conditions.

Impact: Higher scores (more deprived areas) increase calculated CVD risk by ~3% per point.

📏 Clinical Measurementsv

BMI (kg/m²)

Systolic BP (mmHg)

TC/HDL Ratio

SBP Std Dev (QRISK4)

🧬 Lipoprotein(a) - Lp(a) for Risk Enhancement v

Lp(a) Value

Unit

Note: Lp(a) is not part of QRISK3/4 algorithms but elevated levels ≥50 mg/dL indicate enhanced cardiovascular risk and may warrant more aggressive LDL targets per CCS 2021 guidelines.

📈 BP Variability (6+ readings)v

Enter at least 6 BP readings:

#	Date	Systolic	Diastolic	Actions

Mean SBP

mmHg

SBP Std Dev

mmHg

⚖️ QRISK3 vs QRISK4 Comparison

Factor	QRISK3	QRISK4
10-Year CVD Risk	--%	--%
Risk Category	--	--
Heart Age	-- years	-- years
Difference (QRISK4 - QRISK3)	--

QRISK3

QRISK4

Risk Category

Heart Age

years

📛 Reference

QRISK3: Hippisley-Cox J et al. BMJ 2017;357:j2099

QRISK4: Adds BP variability, Long COVID, air pollution factors (2024)

Validation: qrisk.org | NICE CG181

📓 Related References: ❤ CVD Risk Calculators 🌎 Ethnic Considerations 📋 Clinical Guidelines 🔧 Validation Tools

📈 Combined Risk Assessment & International Scores

Compare all risk scores: Framingham, QRISK3/4, PREVENT, SCORE2/SCORE2-OP/SCORE2-Diabetes

📚 Understanding CVD Risk Calculators (Click to Expand)

🇪🇺 SCORE2 Family (ESC 2021/2023)

The Systematic COronary Risk Evaluation 2 (SCORE2) is the European Society of Cardiology's recommended calculator for estimating 10-year risk of fatal and non-fatal CVD events (MI, stroke, CV death) in apparently healthy Europeans without prior CVD.

SCORE2 (Ages 40-69, Non-Diabetic)
Inputs: Age, Sex, Smoking, SBP, Total Cholesterol, HDL-C, Risk Region

SCORE2-OP (Ages 70+, Older Persons)
Same inputs as SCORE2, recalibrated for older populations with different competing risks

SCORE2-Diabetes (Ages 40-69, Type 2 Diabetes) - ESC 2023
Additional inputs: HbA1c, Age at diabetes diagnosis, eGFR. Provides diabetes-specific risk stratification

Key feature: Risk estimates are calibrated to 4 European risk regions based on WHO CVD mortality data.

🇺🇸 PREVENT Equations (AHA 2024)

Predicting Risk of CVD EVENTs is the American Heart Association's newest risk calculator, replacing the 2013 Pooled Cohort Equations (PCE). Based on data from 6.6 million diverse US adults, it estimates 10-year and 30-year risk for ages 30-79.

Key Innovations:

No race variable - promotes equitable risk assessment
Includes Heart Failure - predicts Total CVD, ASCVD, and HF separately
CKM Integration - incorporates BMI, eGFR (cardiovascular-kidney-metabolic factors)
Optional Enhancers - HbA1c, UACR, Social Deprivation Index (SDI)
Statin adjustment - accounts for current statin use

Reference: Khan SS et al. Circulation 2024;149:430-449

✅ Which Calculator Should I Use?

European patient, no diabetes	SCORE2 (40-69) or SCORE2-OP (70+)
European patient with Type 2 DM	SCORE2-Diabetes (preferred)
US/North American patient	PREVENT (with optional enhancers)
UK patient	QRISK3 (NICE-recommended), SCORE2 (ESC)
Young adults (30-39)	PREVENT only (SCORE2 starts at 40)
Heart failure risk focus	PREVENT (includes HF-specific model)

📊 Risk Score Comparison

Framingham 10-Year

QRISK3

QRISK4

SCORE2/OP

SCORE2-Diabetes

PREVENT 10-Year

PREVENT 30-Year

PREVENT ASCVD

PREVENT HF

🫀 Liver Fibrosis & Cardiometabolic Risk Summary

Non-invasive liver fibrosis scores and CKD-liver interaction assessment

FIB-4 Score

Fibrosis index

NAFLD-FS

NAFLD fibrosis

APRI

AST/Plt ratio

ELF Score

Direct markers

CKD-FIB4 Combined Risk

Cardiometabolic

Interpretation Guide:
● FIB-4: <1.30 (low) | 1.30-2.67 (indeterminate) | >2.67 (high)
● NAFLD-FS: <-1.455 (low) | -1.455 to 0.676 (indeterminate) | >0.676 (high)
● ELF: <7.7 (no/mild) | 7.7-9.8 (moderate) | ≥9.8 (advanced fibrosis)
● CKD-FIB4: Combined kidney-liver risk multiplicatively increases CV mortality

🇪🇺 ESC SCORE2 Family Calculator

SCORE2 (ages 40-69) | SCORE2-OP (ages 70+) | SCORE2-Diabetes (Type 2 DM, ages 40-69)

Risk Region

Algorithm Selection

Algorithm Used

10-Year CVD Risk

Risk Category

LDL-C Target

mmol/L

📋 ESC 2021 Risk Thresholds:

Age <50: Low-Mod <2.5% | High 2.5-7.5% | Very High ≥7.5%
Age 50-69: Low-Mod <5% | High 5-10% | Very High ≥10%
Age ≥70 (OP): Low-Mod <7.5% | High 7.5-15% | Very High ≥15%

🇺🇸 AHA PREVENT Calculator (2024)

Predicting Risk of CVD EVENTs - Khan SS et al., Circulation 2024

Estimates 10-year and 30-year risk for Total CVD, ASCVD (MI/Stroke), and Heart Failure in US adults ages 30-79 without prior CVD.

PREVENT Model

BMI (kg/m²)

eGFR (mL/min/1.73m²)

UACR (mg/g) (Enhanced)

HbA1c (%) (If Diabetic)

Currently on Statin Therapy

On Antihypertensive Therapy

Social Deprivation Index (1-10) (Optional - Full Model)

📍 About Social Deprivation Index (SDI): ZIP code-based composite measuring poverty, education, housing, employment, and healthcare access. Scale: 1 (least deprived) to 10 (most deprived). Lookup: graham-center.org/maps | Non-US: Use 5 (average) or local equivalent.

📊 PREVENT Risk Estimates

Total CVD 10-Year

Total CVD 30-Year

ASCVD 10-Year

Heart Failure 10-Year

Risk Category

Model Used

📋 PREVENT Risk Thresholds (Anticipated ACC/AHA 2025):

Low: <5% (lifestyle modification)
Borderline: 5-7.5% (consider risk enhancers, lifestyle)
Intermediate: 7.5-20% (moderate-intensity statin if risk discussion favorable)
High: ≥20% (high-intensity statin recommended)

💊 Treatment Effect Simulator

Model the impact of various treatments on your cardiovascular risk

📊 Current Risk Profile

Current LDL-C (mg/dL)

Current SBP (mmHg)

Baseline 10-yr Risk (%)

Target LDL-C (mg/dL)

💉 Select Treatments to Simulate

High-Intensity Statin (50% LDL↓, 35% RR↓) Moderate-Intensity Statin (35% LDL↓, 25% RR↓) + Ezetimibe (18% additional LDL↓) + PCSK9 Inhibitor (60% additional LDL↓) Antihypertensive Therapy (~10 mmHg↓, 20% RR↓/10mmHg) SGLT2 Inhibitor (30% HF↓, 10% MACE↓) GLP-1 RA (14% MACE↓, 3-7% weight loss)

🔮 What-If Scenario Modeling

Compare your current risk against optimized scenarios

💊 Ready for Treatment Planning?

View evidence-based treatment recommendations based on your calculated risk scores

📄 Export Complete Report

Generate a comprehensive PDF report with all risk scores, laboratory values, visualizations, and treatment recommendations.

📓 Related References: ❤ CVD Risk Calculators 💉 Lipid Science 📋 Clinical Guidelines 🫘 eGFR Methods

💚 Cardiorenal Protection Assessment

Diabetes Canada 2024 GLP-1 RA/SGLT2i Guidelines + KDIGO 2024 CKD Staging

🏥 CKD Staging (KDIGO 2024)

Serum Creatinine

Albumin-to-Creatinine Ratio (ACR)

eGFR Calculation Method

Calculated eGFR

-- mL/min/1.73m²

📉 Kidney Failure Risk Equation (KFRE)

4-variable KFRE for patients with eGFR <60

Prediction Timeframe

❤️ Cardiorenal Indications

💥 Type 2 Diabetes ❤ Atherosclerotic CVD 💚 Heart Failure 🏥 Chronic Kidney Disease 💧 Albuminuria (ACR >3) ⚠️ High CV Risk (≥2 factors)

💊 Current Cardiorenal Therapy

💉 GLP-1 RA Therapy

⭕ GLP-1 RA: Not on therapy

💊 SGLT2 Inhibitor

⭕ SGLT2i: Not on therapy

💊 Statin Therapy

⭕ Statin: Not on therapy

❤️ RAAS Blockade

⭕ ACEi/ARB: Not on therapy

📋 Cardiorenal Assessment

📚 Quick Reference: Cardiorenal Agents

GLP-1 RA Options (MACE Benefit)

Semaglutide (Ozempic)	26% MACE ↓
Semaglutide (Rybelsus)	14% MACE ↓
Liraglutide (Victoza)	13% MACE ↓
Dulaglutide (Trulicity)	12% MACE ↓

SGLT2i Options (by eGFR)

Empagliflozin (Jardiance)	eGFR ≥20
Dapagliflozin (Forxiga)	eGFR ≥25
Canagliflozin (Invokana)	eGFR ≥30

HF benefit independent of diabetes status

References: Diabetes Canada 2024 CPG, CCS 2022 GLP-1/SGLT2 Guidelines, KDIGO 2024

💊 Medication Dose Adjustment by eGFR (KDIGO 2024)

Select a medication to see dose recommendations based on current eGFR

Select Medication

Current eGFR (mL/min/1.73m²)

⚠ Important: Always verify dose adjustments with current product monograph and consider individual patient factors. Consult nephrology for eGFR < 30 mL/min.

🏥 Nephrology Referral Criteria (KDIGO 2024)

🚨 Urgent Referral

eGFR < 15 mL/min (unless stable on dialysis)
Rapid eGFR decline > 5 mL/min/year
UACR > 300 mg/g with hematuria
Refractory hypertension (> 4 agents)
Hyperkalemia > 6.0 mEq/L
Suspected glomerulonephritis

📋 Routine Referral

eGFR < 30 mL/min
UACR > 300 mg/g
Sustained eGFR decline > 3 mL/min/year
Unexplained anemia (Hgb < 10 g/dL)
Resistant hypertension
Unexplained hematuria

🧬 Lipoprotein(a) Assessment

Comprehensive Lp(a) risk evaluation and family cascade screening

👨 Why This Toolkit Was Created

This toolkit was created because of my personal family history with elevated Lipoprotein(a). After discovering my own elevated Lp(a) levels, I learned that this genetic risk factor affects approximately 1 in 5 people worldwide, yet remains vastly under-tested and under-recognized.

Because Lp(a) is ~90% genetically determined, there's a 50% chance that first-degree relatives (parents, siblings, children) also have elevated levels. This makes cascade screening critically important for identifying at-risk family members early.

My goal is to help clinicians and patients better understand this often-overlooked cardiovascular risk factor and facilitate appropriate testing and family screening. Early awareness can lead to more aggressive management of modifiable risk factors and potentially life-saving interventions.

Emerging therapies targeting Lp(a), including antisense oligonucleotides and small interfering RNAs (siRNAs), are currently in Phase 3 clinical trials and may soon provide the first effective treatments for this genetic condition.

-- Manjinder Singh Nanrey

🔬 Lp(a) Risk Assessment

Lp(a) Value

Unit

📛 Key Lp(a) Facts

🧬 Genetic Determination:

Lp(a) levels are approximately 90% genetically determined and remain stable throughout life. Unlike LDL-C, diet and exercise have minimal impact on Lp(a) levels.

⚠️ Prevalence & Underdiagnosis:

Approximately 20% of the global population has elevated Lp(a). However, fewer than 1% of at-risk individuals have been tested, making it one of the most underdiagnosed cardiovascular risk factors.

¤ Cardiovascular Impact:

Elevated Lp(a) is an independent risk factor for atherosclerotic CVD, aortic stenosis, and heart failure. Risk increases progressively with Lp(a) levels, with extreme levels (>180 mg/dL) conferring 3× baseline risk.

💊 Management Strategies:

Current management focuses on aggressive LDL-C lowering, with PCSK9 inhibitors providing modest (20-25%) Lp(a) reduction. Niacin also lowers Lp(a) but has limited cardiovascular benefit. Novel RNA-based therapies (olpasiran, pelacarsen) show 80-90% reduction in trials.

👨-👩-👧-👪 Family Cascade Screening Calculator

Calculate potential impact of screening first-degree relatives (~90% heritability):

# Living Parents

# Siblings

# Adult Children

📊 Lp(a) Risk Thresholds

Category	mg/dL	nmol/L	Risk Multiplier
Normal	<30	<75	1.0×
Borderline	30-49	75-124	1.2×
Elevated	50-79	125-199	1.5×
Very High	≥80	≥200	2.0×
Extreme	≥180	≥450	3.0×

⚠️ Unit Conversion Warning: Lp(a) conversion is assay-dependent (typically 2.0-2.5× factor). Verify with lab-specific conversion.

📓 Related References: 🧬 Lp(a) Science 💉 Lipid Science 🌎 Ethnic Variations 📋 Clinical Guidelines

📉 Data Visualizations

Interactive charts for comprehensive risk assessment analysis

Primary Chart Type

Chart Theme

Show Target Lines

📊 Dashboard Overview

Risk Score Summary

Lipid Profile

Biomarker Overview

Risk Factor Distribution

🧬 Lp(a) Risk Visualization

Lp(a) Risk Modifier Impact

Cascade Screening Impact

📊 Advanced D3.js Visualizations

Risk Gauge

Biomarker Heatmap

Risk Timeline

Risk Factor Network

📓 Assessment History

View, compare, and manage saved assessments

Filter by Date

Filter by Risk Level

Sort By

Total Assessments

Avg Risk Score

Risk Trend

Last Assessment

	Date/Time	Patient ID	FRS Base / Lp(a)	QRISK3	QRISK4	PREVENT 10y	PREVENT 30y	Lp(a)	BRI	Actions
📋 No saved assessments yet. Complete an assessment and click "Save Assessment" to build your history.

📋 Table Columns: FRS = Framingham Risk Score (Base% / Lp(a)-adjusted%) | QRISK3/4 = UK-validated risk | PREVENT = AHA 2024 (10-year and 30-year) | Lp(a) & BRI highlighted

📈 Risk Trend Analysis

💾 Session History Viewer

Total Sessions

Unique Patients

Total Calculations

Avg Session

Session ID	Start Time	Patient ID	Calculations	Duration	Actions
Click "Load Sessions" to view session history

⏯ EventBus Event Replay

Progress

Current

Total

Status

Idle

📜 Event Queue

Load events to see queue

✅ Executed Events

No events executed yet

💡 Event Replay: Replay recorded EventBus events to debug workflows, reproduce issues, or demonstrate features. Events are re-emitted through the EventBus in sequence with optional delays for visibility.

🔒 Data Persistence & Backup

Protected

File System Backup

Not Configured

OPFS Storage

Checking...

Last Backup

Never

Backup Count

🛡 Data Protection Features

File System Access: Save backups to a folder that survives browser data clearing (Chrome/Edge)
Origin Private File System: Browser-managed persistent storage with higher retention
Auto-Backup: Automatic backups every 15 minutes to multiple locations
Download Backups: Manual download backup as a failsafe
Storage Pressure Detection: Automatic emergency backup when storage is low

📀 Version History & Rollback

Saved Versions

Current Version

Never

Last Saved

Version	Date/Time	Description	Fields	Actions
Click "Load History" to view saved versions

⚠️ Rollback Warning: Rolling back will overwrite current data. A backup of the current state will be created automatically before rollback.

📁 Import / Export Data

Import from files, paste lab reports, batch import patients, or capture images

📤 Import Data

📁

Drag & Drop Files Here
or click to browse

Supported: JSON, CSV, PDF (OCR), Images (OCR), Excel (.xlsx)

👥 Batch Patient Import

Import multiple patients from CSV or Excel. Each patient will receive a unique CVD-YYYYMMDD-XXXXXXXX ID.

📋 Required CSV/Excel Columns:

                        name, age, sex, sbp, dbp, tc, ldl, hdl, triglycerides, smoking, diabetes

                        Optional: creatinine, hba1c, lipoa, waist, hip, weight, height, egfr

Select CSV or Excel File

📋 Paste Lab Report

Copy and paste a lab report directly below. The system will automatically extract patient info, lab values, and populate fields.

Lab Report Text

📤 Export Data

Export Format

Patient Data Lab Results Medications Calculations Cardiorenal Assessment

🔒 Encrypted Export/Import

Securely transfer patient data between systems with AES-256-GCM encryption and digital signature verification.

Security: Files are encrypted with AES-256-GCM and signed for authenticity verification.
Only CVD Toolkit can decrypt and verify these packages.

⚙ Settings

Configure application preferences

🎨 Appearancev

Theme

Text Size

📏 Default Unitsv

Unit System

Lipid Units

š¡ Behaviorv

Auto-save data Auto-calculate on input Show explanations Enable keyboard shortcuts Confirm before clearing

🔒 Data Managementv

📂 Session Recovery

If you previously chose "Decide Later" when prompted to restore a session, you can manually restore it here.

Checking for saved sessions...

📃 Version History & Rollback

The toolkit automatically saves versions of your data. You can view history and restore previous versions if needed.

Versions saved: 0 Last save: --

Note: Up to 50 versions are stored locally. Older versions are automatically removed.

🧠 Memory Management

Monitor and optimize memory usage for better performance.

Memory Used:
--

Memory Health:
Good

⚡ Performance & Accelerationv

💻 System Status

GPU Acceleration:
Checking...

WebWorker Pool:
Checking...

OCR Engine:
Checking...

PDF Generator:
Checking...

📊 Performance Metrics

GPU Calculations: 0
Worker Calculations: 0
CPU Calculations: 0
Total Time: 0ms

💾 Storage Information

Local Storage: Calculating...

IndexedDB: Available

Encryption: AES-256-GCM (when enabled)

🚀 Future Projects & Research Roadmap

Our vision for advancing cardiovascular risk assessment and Lp(a) understanding

🧬 Lipoprotein(a) Research Initiative v

Our Mission

Lipoprotein(a) affects approximately 20% of the global population at levels associated with increased cardiovascular risk, yet remains one of the most underdiagnosed and undertreated risk factors. This toolkit is designed to raise awareness, improve screening rates, and support clinical decision-making for patients with elevated Lp(a).

Personal motivation: This project stems from a family history with elevated Lp(a), driving our commitment to advancing understanding and treatment of this inherited risk factor.

🔬 Research & Education Goals

Cascade Screening Advocacy: Developing tools and educational materials to promote systematic family screening when elevated Lp(a) is identified
Risk Communication: Creating patient-friendly visualizations to explain Lp(a)'s role in cardiovascular disease
Guideline Integration: Aligning with CCS 2021, EAS 2022, and emerging ACC/AHA recommendations for Lp(a) screening and management
Clinical Decision Support: Building evidence-based algorithms to help clinicians stratify patients for aggressive lipid therapy
Emerging Therapies Tracking: Monitoring Phase 3 trials of Lp(a)-lowering agents (pelacarsen, olpasiran, lepodisiran)

💊 Emerging Lp(a)-Lowering Therapies

Drug	Mechanism	Lp(a) Reduction	Status
Pelacarsen	ASO targeting LPA mRNA	~80%	Phase 3 (Lp(a)HORIZON)
Olpasiran	siRNA targeting LPA	~95%	Phase 3 (OCEAN-Outcomes)
Lepodisiran	siRNA targeting LPA	~96%	Phase 2 completed
SLN360	siRNA targeting LPA	~90%	Phase 2

* Phase 3 outcomes trials expected to report 2025-2026. These may establish first-ever Lp(a)-specific therapies.

📛 Key Resources

Lipoprotein(a) Foundation - Patient advocacy and education
European Atherosclerosis Society - Lp(a) consensus statements
Family Heart Foundation - FH and Lp(a) screening programs

✨ Version 22.0 (Q1 2025)v

Polygenic Risk Score Integration: Incorporate CAD-PRS, AF-PRS for enhanced genetic risk stratification
Lp(a) Percentile Calculator: Population-based percentiles with ethnicity-specific distributions
Wearable Device Sync: Apple Health, Google Fit, Fitbit integration for continuous BP and activity data
SCORE2/SCORE2-OP: Add European cardiovascular risk calculators for EU populations
Multi-Language Support: French, Spanish, Mandarin, Hindi, Punjabi translations
AI-Powered Lab Interpretation: Natural language summaries of lipid panel results

✨ Version 28.0 (Q3 2025)v

EHR Integration via FHIR R4: Bidirectional data exchange with Epic, Cerner, MEDITECH
Telemedicine Portal: Secure patient-clinician dashboard with shared assessments
Prescription Integration: CDS Hooks for real-time statin/PCSK9i recommendations
Advanced OCR/AI: Photo-to-data for lab reports with 99%+ accuracy
Population Health Analytics: Aggregate de-identified trends for quality improvement
Voice Input: Hands-free data entry via speech recognition

🔬 Research Collaborations (2025-2027)v

Lp(a) Registry Initiative: Anonymous contribution of Lp(a) values with outcomes for research
UK Biobank Integration: Validation of risk models against 500,000+ participant cohort
Million Veteran Program: Collaboration for diverse population risk modeling
Academic Partnerships: Collaborations with cardiovascular research centers for algorithm validation
Biomarker Discovery: Identifying novel CVD risk factors beyond traditional panels
Pharmacogenomics: Statin response prediction based on genetic markers

🤖 Advanced Technology (Long-term Vision)v

Machine Learning Risk Prediction: Deep learning models trained on longitudinal outcomes
Digital Twin Modeling: Personalized cardiovascular simulation for treatment optimization
Continuous Glucose Monitoring Integration: Real-time metabolic risk assessment
Cardiac Imaging AI: CCTA calcium score interpretation and plaque analysis
Blockchain Health Records: Patient-controlled data sharing for research
Augmented Reality Training: Clinical education modules for CVD risk assessment

💡 Have suggestions? We prioritize features based on clinical impact and user feedback. All development is driven by the goal of improving cardiovascular outcomes and advancing Lp(a) awareness.

⚠️ Research Notice: This toolkit is an educational resource and research support tool. It is not intended to replace professional medical judgment. All clinical decisions should be made by qualified healthcare providers.

❤️ Support This Project

Your donation keeps the CVD Toolkit free and helps fund server costs, AI development, and clinical updates.

☕ Buy Us a Coffee on Ko-fi

❓ Help & Clinical References

Quick start guide, shortcuts, and citations

❤️ Support This Projectv

Scan QR or click to donate

☕ Support Further Development

Your donation helps support:

💻 Web Server Hosting: Keeping the toolkit accessible online
🤖 AI Subscription: Continued development using AI assistance
🔬 New Features: Quantum computing integration, ML risk prediction
📚 Clinical Updates: Keeping guidelines current (CCS, AHA/ACC, ESC)
📱 Mobile Optimization: Enhanced experience on all devices

☕ Buy Us a Coffee

Every contribution helps keep this project alive. Thank you! 🙏

🐛 Unified Diagnostic System v28.20v

Run comprehensive 15-section diagnostics integrating all testing frameworks with automatic GitHub issue creation.

📋 Unified Report Sections (15):

1. Module Health (55) 2. CVDTestSuite 3. ValidationSuite 4. Stress Tests 5. Predictive Maint. 6. Module Comm. 7. Process Tree 8. Performance 9. Memory Usage 10. Storage Status 11. Browser Features 12. Console Summary 13. Error Analysis 14. Edge Cases 15. Calc Accuracy

📤 GitHub Auto-Upload: Reports are automatically uploaded to wazscience/debugging-support as issues with labels based on severity.

📊 Debug Results

📡 EventBus Performance Monitor

Emitted

Handled

Dropped

Errors

Subscriptions

100%

Success Rate

📊 Top Events

No events yet

⏱ Recent Activity

No recent activity

📝 Registered Events (0)

🧪 EventBus Unit Tests

Click "Run Tests" to execute EventBus unit tests

🚀 Quick Start Guidev

Patient Demographics: Enter age, sex, height, weight, waist, hip, BP
Medications & Labs: Input medications and all lab panels
Framingham: Calculate 10-year CHD risk with Lp(a) modifier
QRISK3/4: UK-validated CVD risk with 14+ conditions
Combined Results: Compare all scores, calculate PREVENT
Lp(a) Assessment: Evaluate risk and cascade screening
Save/Export: Save assessments and export reports

⌨ Keyboard Shortcutsv

Shortcut	Action
`Alt` + `1-9, 0`	Switch tabs 1-10
`Ctrl` + `S`	Save assessment
`Ctrl` + `N`	New patient / Clear
`Ctrl` + `P`	Print report
`Ctrl` + `E`	Export data

⚖️ Legal Disclaimerv

⚕️ Clinical Use Disclaimer Status

Status: Checking...

Version: 3.0.0

Accepted: --

Expires: --

You must accept the Clinical Use Disclaimer to use this application. Consent is valid for 30 days and will require re-acceptance after expiration.

🧠 ML Data Collection Consent

Status:

Consented:

Optional anonymous data collection to improve cardiovascular risk prediction models. All data is de-identified and encrypted with AES-256-GCM.

⚠️ Important Notice

This application is intended for use by qualified healthcare professionals only. All risk calculations should be verified independently using official calculators for clinical decision-making.

📋 Clinical Use Disclaimer (v3.0.0)

1. EDUCATIONAL AND INFORMATIONAL PURPOSES ONLY

This CVD Risk Assessment Application ("Application") is provided solely for educational and informational purposes. It is designed to assist qualified healthcare professionals in cardiovascular risk assessment but is not intended to replace professional medical judgment, diagnosis, or treatment.

2. NOT A MEDICAL DEVICE

This Application is NOT a licensed, registered, or approved medical device under any jurisdiction including Health Canada, the FDA (USA), or CE marking (EU). The risk scores and recommendations generated should be considered supplementary information only and must be independently verified.

3. PROFESSIONAL RESPONSIBILITY

Healthcare professionals using this Application bear sole and complete responsibility for all clinical decisions made in connection with patient care. This includes:

Verification of all calculations using official validated calculators
Consideration of all relevant patient factors not captured by risk algorithms
Exercise of independent clinical judgment
Adherence to current clinical guidelines and institutional policies

4. ALGORITHM LIMITATIONS

The risk algorithms implemented (Framingham, QRISK3, QRISK4, PREVENT) were developed and validated in specific populations. Accuracy may vary when applied to:

Populations outside original derivation cohorts
Patients with conditions not included in model development
Clinical scenarios with multiple comorbidities
Extreme values outside typical ranges

5. NO WARRANTY

THIS APPLICATION IS PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. THE CREATORS EXPRESSLY DISCLAIM ALL WARRANTIES INCLUDING MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT.

6. LIMITATION OF LIABILITY

THE CREATORS SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES ARISING FROM USE OF THIS APPLICATION, INCLUDING BUT NOT LIMITED TO PATIENT HARM, TREATMENT ERRORS, OR ADVERSE CLINICAL OUTCOMES.

🔒 Data Privacy & Security Notice (v3.0.1)

LOCAL PROCESSING: All calculations are performed locally within your browser. No patient data is transmitted to external servers by default.

DATA STORAGE: The Application may temporarily store data in browser local storage for session management. This data remains on your device.

REGIONAL COMPLIANCE:

🇨🇦 Canada (PIPEDA): Users must ensure compliance with provincial health information legislation
🇺🇸 USA (HIPAA): PHI handling is your responsibility as a covered entity
🇪🇺 EU (GDPR): You are the data controller for any patient data entered

ENCRYPTION: When enabled, data is encrypted using AES-256-GCM. However, no electronic system is 100% secure.

RECOMMENDATION: Anonymize or de-identify patient data before entry. Do not enter full patient names, health card numbers, or other direct identifiers.

💊 Medication Recommendations Disclaimer (v1.0.0)

GUIDANCE ONLY: Medication recommendations are based on CCS 2021 Guidelines for Dyslipidemia and serve as general guidance only.

PRESCRIBING RESPONSIBILITY: The healthcare professional bears full responsibility for all prescribing decisions including:

Reviewing patient allergies and contraindications
Checking drug-drug interactions
Verifying dosing appropriateness
Monitoring for adverse effects

⚠️ WARNING: This Application does NOT independently verify drug allergies, contraindications, or interactions.

💉 PCSK9 Inhibitor Eligibility Disclaimer (v1.0.0)

BC PHARMACARE CRITERIA: PCSK9 eligibility assessments are based on publicly available BC PharmaCare Special Authority criteria. These may not reflect current criteria or individual case variations.

NO GUARANTEE: Eligibility assessments do not guarantee actual coverage approval. Always verify directly with the relevant provincial formulary.

CONSULT OFFICIAL SOURCES: For actual Special Authority applications, consult the official BC PharmaCare forms and current criteria at gov.bc.ca/pharmacare

🔒 Privacy & Data Collectionv

🔐 Data Security

All ML training data is encrypted with AES-256-GCM before transmission. Encryption keys are derived using PBKDF2 with 100,000 iterations. Your consent preferences are stored locally on your device.

📋 What Data is Collected

Anonymized calculation inputs - Age ranges (not exact), rounded lab values
Risk score outputs - Framingham, QRISK3, PREVENT scores
Biomarker patterns - Lp(a), ApoB, eGFR distributions
Usage statistics - Which calculators are used most

⛔ What is NEVER Collected

Patient names, IDs, or any identifiers
Exact dates of birth or precise ages
Geographic location or addresses
Any information that could identify individuals

🎯 How Data is Used

Train ML models for better CVD prediction
Research novel biomarker correlations
Validate calculator algorithms
Improve future toolkit versions

💡 Your Control: You must explicitly consent before any data is collected. You can revoke consent at any time, and all preferences are stored locally on your device. No data is ever collected without your permission.

📴 Using the Toolkit Offlinev

📱 Install as App (Progressive Web App)

This toolkit can be installed on your device and used offline without an internet connection. All calculations work locally - no data is ever sent to servers.

🖥 Desktop (Chrome, Edge, Firefox)

Look for the install icon (+ or 📤) in the browser address bar
Click it and select "Install" or "Add to Home Screen"
The toolkit will open as a standalone app window
It will now be available in your Start Menu / Applications folder

📱 iPhone / iPad (Safari)

Open the toolkit in Safari (required for iOS)
Tap the Share button (square with arrow pointing up)
Scroll down and tap "Add to Home Screen"
Tap "Add" in the top right corner
The toolkit will appear as an app icon on your home screen

📱 Android (Chrome)

Open the toolkit in Chrome
Tap the three-dot menu (⋮) in the top right
Tap "Install app" or "Add to Home Screen"
Confirm by tapping "Install"
The toolkit will appear in your app drawer

📴 How Offline Mode Works

First Visit: The toolkit downloads and caches all necessary files
Subsequent Visits: Works entirely from cache - no internet required
Data Storage: Patient data is stored encrypted in your browser's IndexedDB
Auto-Save: Changes are automatically saved every 30 seconds
Updates: When online, the toolkit checks for updates automatically

⚠️ Important Notes:

Clearing browser data will delete saved patient assessments
The offline indicator (📴) appears in the header when disconnected
Export your data regularly as a backup (JSON format)
Chart visualizations require Chart.js to load on first use

📱

Offline Status

Checking...

📦 PWA Assets Download

Download icons and manifest for self-hosting or server deployment.

Icon sizes included: 72, 96, 128, 144, 152, 192, 384, 512px

📛 Clinical References (100+ Citations)v

❤ CVD Risk Assessment Calculators

Framingham (Original): D'Agostino RB et al. General cardiovascular risk profile for use in primary care. Circulation 2008;117:743-53. DOI: 10.1161/CIRCULATIONAHA.107.699579
QRISK3: Hippisley-Cox J et al. Development and validation of QRISK3. BMJ 2017;357:j2099. DOI: 10.1136/bmj.j2099
QRISK3 Source Code: ClinRisk Ltd. Official QRISK3-2017 C implementation (GNU LGPL v3). qrisk.org/src.php - Used for v28.20 calibration
QRISK4: Hippisley-Cox J et al. QRISK4: An updated algorithm. BMJ 2024. qrisk.org/QRISK4
PREVENT Equations: Khan SS et al. Novel PREVENT equations (10-year and 30-year CVD risk). Circulation 2024;149:e1144-e1156. DOI: 10.1161/CIR.0000000000001191
SCORE2: SCORE2 Working Group. SCORE2 risk prediction algorithms: age-specific cardiovascular risk charts for persons without known CVD. Eur Heart J 2021;42:2439-2454. DOI: 10.1093/eurheartj/ehab309 - Used for v28.20 calibration
SCORE2-OP: SCORE2-OP Working Group. SCORE2-OP risk prediction algorithms for older persons (≥70 years). Eur Heart J 2021;42:2455-2467. DOI: 10.1093/eurheartj/ehab312 - Used for v28.20 calibration
SCORE2-Diabetes: SCORE2-Diabetes Working Group. CVD risk estimation for persons with Type 2 diabetes. Eur Heart J 2023;44:2544-2556. DOI: 10.1093/eurheartj/ehad260
Reynolds Risk Score: Ridker PM et al. Circulation 2007;115:450-8. DOI: 10.1161/CIRCULATIONAHA.106.659482
Pooled Cohort Equations: Goff DC et al. ACC/AHA guidelines. Circulation 2014;129:S49-73. DOI: 10.1161/01.cir.0000437741.48606.98

✅ v28.20 Calibration Notes: QRISK3 implementation uses official ClinRisk fractional polynomial coefficients with sex-specific transforms (female: age^-2, age; male: age^-1, age³), exact centering constants from derivation cohort, and complete age interaction terms. SCORE2/SCORE2-OP use ESC 2021 Fine-Gray competing risk model with region-specific baseline survival functions.

🧬 Lipoprotein(a) Science

EAS Consensus Statement: Kronenberg F et al. Lipoprotein(a) in atherosclerotic CVD and aortic stenosis. Eur Heart J 2022;43:3925-46. DOI: 10.1093/eurheartj/ehac361
Lp(a) Risk Enhancement: Kamstrup PR et al. Extreme Lp(a) levels and risk of MI. JAMA 2009;301:2331-9. DOI: 10.1001/jama.2009.801
Genetic Causality: Burgess S et al. Lp(a) and CHD - Mendelian randomization. J Am Coll Cardiol 2018;72:1959-70. DOI: 10.1016/j.jacc.2018.07.084
PCSK9 + Lp(a): O'Donoghue ML et al. ODYSSEY OUTCOMES. Circulation 2019;139:1483-92. DOI: 10.1161/CIRCULATIONAHA.118.037184
Cascade Screening: Tsimikas S et al. Role of Lp(a) in cardiovascular disease. J Am Coll Cardiol 2021;78:634-49. DOI: 10.1016/j.jacc.2021.06.011
Ethnic Variation: Enkhmaa B et al. Lipoprotein(a) and ethnicity. Atherosclerosis 2016;249:44-51. DOI: 10.1016/j.atherosclerosis.2016.03.031
Aortic Stenosis Risk: Arsenault BJ et al. Lp(a) levels and aortic valve calcification. J Am Coll Cardiol 2014;63:1724-30. DOI: 10.1016/j.jacc.2013.12.046

💉 Lipid & Apolipoprotein Science

ApoB Superiority: Sniderman AD et al. Apolipoprotein B vs LDL cholesterol. Lancet 2022;399:2173-84. DOI: 10.1016/S0140-6736(22)00624-0
Non-HDL Cholesterol: Brunner FJ et al. Residual risk after LDL lowering. Circulation 2019;140:305-14. DOI: 10.1161/CIRCULATIONAHA.118.039115
TRL Remnants: Varbo A et al. Remnant cholesterol and ischemic heart disease. JAMA 2013;309:2084-91. DOI: 10.1001/jama.2013.5679
TC/HDL Ratio: Gaziano JM et al. Fasting triglycerides, HDL, and risk of MI. Circulation 1997;96:2520-25. DOI: 10.1161/01.cir.96.8.2520
ApoB/ApoA1 Ratio: Walldius G et al. AMORIS study. Lancet 2001;358:2026-33. DOI: 10.1016/S0140-6736(01)07098-2

📏 Anthropometric Measures

Body Roundness Index: Thomas DM et al. A simple validated model for predicting body fat. Obesity 2013;21:E338-42. DOI: 10.1002/oby.20408
BRI vs BMI: Rico-Martin S et al. BRI effectiveness in detecting metabolic syndrome. Nutrients 2020;12:E3302. DOI: 10.3390/nu12113302
Waist-Hip Ratio: Yusuf S et al. INTERHEART Study. Lancet 2005;366:1640-9. DOI: 10.1016/S0140-6736(05)67663-5
BMI Limitations: Prentice AM, Jebb SA. Beyond BMI. Obes Rev 2001;2:141-7. DOI: 10.1046/j.1467-789x.2001.00031.x

🫁 Liver Function & Fibrosis

FIB-4 Index: Sterling RK et al. Development of a simple noninvasive index. Hepatology 2006;43:1317-25. DOI: 10.1002/hep.21178
FIB-4 Validation: McPherson S et al. Validation of FIB-4 for NAFLD. Gut 2017;66:138-45. DOI: 10.1136/gutjnl-2015-310864
NAFLD & CVD: Targher G et al. NAFLD and increased risk of CVD. Gut 2017;66:1386-96. DOI: 10.1136/gutjnl-2015-310683
AST/ALT Ratio: Williams AL, Hoofnagle JH. Ratio of serum AST to ALT. Gastroenterology 1988;95:734-9. DOI: 10.1016/s0016-5085(88)80022-2

🫘 Kidney Function & eGFR

CKD-EPI 2021: Inker LA et al. New creatinine- and cystatin C-based equations. N Engl J Med 2021;385:1737-49. DOI: 10.1056/NEJMoa2102953
CKD-EPI 2009: Levey AS et al. A new equation to estimate GFR. Ann Intern Med 2009;150:604-12. DOI: 10.7326/0003-4819-150-9-200905050-00006
KDIGO 2024 CKD Guidelines: Kidney Disease: Improving Global Outcomes (KDIGO). Clinical Practice Guideline for CKD Evaluation and Management. KDIGO CKD Guidelines
KFRE (Kidney Failure Risk Equation): Tangri N et al. A predictive model for progression of CKD to kidney failure. JAMA 2011;305:1553-9. DOI: 10.1001/jama.2011.451
CKD & CVD Risk: Go AS et al. Chronic kidney disease and cardiovascular risk. N Engl J Med 2004;351:1296-305. DOI: 10.1056/NEJMoa041031
Diabetes Canada Cardiorenal: McFarlane P et al. Chronic Kidney Disease in Diabetes. Can J Diabetes 2024. guidelines.diabetes.ca

🔬 Metabolic & Glycemic Markers

HOMA-IR: Matthews DR et al. Homeostasis model assessment. Diabetologia 1985;28:412-9. DOI: 10.1007/BF00280883
HbA1c Target: American Diabetes Association. Glycemic targets. Diabetes Care 2024;47(Suppl 1):S158-S178. DOI: 10.2337/dc24-S006
Fasting Glucose: DECODE Study Group. Glucose tolerance and CVD mortality. Lancet 1999;354:617-21. DOI: 10.1016/S0140-6736(98)12131-1

🔥 Inflammatory Markers

hs-CRP: Ridker PM et al. C-reactive protein and risk prediction. N Engl J Med 2002;347:1557-65. DOI: 10.1056/NEJMoa021993
JUPITER Trial: Ridker PM et al. Rosuvastatin and elevated hs-CRP. N Engl J Med 2008;359:2195-207. DOI: 10.1056/NEJMoa0807646
CANTOS Trial: Ridker PM et al. Antiinflammatory therapy with canakinumab. N Engl J Med 2017;377:1119-31. DOI: 10.1056/NEJMoa1707914

🩸 Hematology & Blood Counts

ANC Calculation: Marrowforums.org validated calculator. marrowforums.org/anc.html
Neutropenia Grading: Common Terminology Criteria for Adverse Events (CTCAE) v5.0. NCI CTCAE
Platelet Reference: Kaushansky K et al. Williams Hematology, 9th Ed. McGraw-Hill 2016.

📋 Clinical Guidelines

CCS 2021 Dyslipidemia: Pearson GJ et al. CCS Guidelines. Can J Cardiol 2021;37:1129-50. DOI: 10.1016/j.cjca.2021.03.016
AHA/ACC 2019: Arnett DK et al. Guideline on primary prevention. Circulation 2019;140:e596-e646. DOI: 10.1161/CIR.0000000000000678
ESC 2021: Visseren FLJ et al. ESC Prevention Guidelines. Eur Heart J 2021;42:3227-337. DOI: 10.1093/eurheartj/ehab484
SCORE2 (ESC 2021): SCORE2 Working Group. SCORE2 risk prediction algorithms. Eur Heart J 2021;42:2439-54. DOI: 10.1093/eurheartj/ehab309
SCORE2-OP (ESC 2021): SCORE2-OP Working Group. Prediction algorithms for older persons. Eur Heart J 2021;42:2455-67. DOI: 10.1093/eurheartj/ehab312
SCORE2-Diabetes (ESC 2023): SCORE2-Diabetes Working Group. 10-year CVD risk estimation for persons with Type 2 diabetes. Eur Heart J 2023;44:2544-2556. DOI: 10.1093/eurheartj/ehad260
AHA PREVENT (2024): Khan SS et al. Novel PREVENT equations for 10-year and 30-year CVD risk. Circulation 2024;149:e1144-e1156. DOI: 10.1161/CIR.0000000000001191
NICE CVD Prevention: NICE guideline CG181. Lipid modification. NICE CG181
BC PharmaCare PCSK9: Special Authority Criteria 2024. BC PharmaCare

🌎 Ethnic & Regional Considerations

South Asian CVD Risk: Gupta M et al. South Asians and cardiovascular risk. Can J Cardiol 2006;22:193-7. DOI: 10.1016/s0828-282x(06)70893-4
MASALA Study: Kanaya AM et al. Mediators of Atherosclerosis in South Asians. J Clin Lipidol 2013;7:561-70. DOI: 10.1016/j.jacl.2013.05.006
African Ancestry: Carnethon MR et al. Cardiovascular health in African Americans. Circulation 2017;136:e393-e423. DOI: 10.1161/CIR.0000000000000534
Indigenous Health: Heart and Stroke Foundation of Canada. Indigenous peoples. heartandstroke.ca

🔧 Validation Tools & External Calculators

qrisk.org - Official QRISK3/QRISK4 Calculator
framinghamheartstudy.org - Framingham Heart Study
ACC ASCVD Risk Estimator Plus
heartscore.org - ESC SCORE2/SCORE2-OP Calculator
ESC SCORE2-Diabetes Calculator - Type 2 Diabetes Risk
AHA PREVENT Calculator - Official PREVENT Equations (10-year & 30-year)
kidney.org eGFR Calculator
marrowforums.org/anc.html - ANC Calculator
MDCalc CKD-EPI 2021
MDCalc FIB-4 Calculator

📛 Citation Note: All DOI links verified as of December 2024. Click any DOI to access the source publication.

ℹ Aboutv

CVD Risk Toolkit v28.22

Created by: Manjinder Singh Nanrey

v28.20 Features:

Patient ID Integration: All calculations linked to active Patient ID with timestamps
QRISK3 vs QRISK4 Comparison: Side-by-side table with difference analysis and factor breakdown
Enhanced CSV Export: 30+ column export with all risk scores and clinical data
JSON Export: Full assessment history export for data portability
Family Cascade Screening: Detailed impact analysis with NNT and patient record linking
Enhanced Mobile Responsiveness: Optimized for tablets and smartphones with touch-friendly controls
Height ft/in: Compound input fields with live conversion display
Weight st/lb: Stone/pounds support for UK users
9-Column History Table: FRS Base/Lp(a), QRISK3, QRISK4, PREVENT 10y/30y, Lp(a), BRI
90+ Clinical References: DOI links across 12 categories
Cross-Tab Navigation: Quick links from calculators to relevant references

⚠️ Medical Disclaimer: This toolkit is for educational and clinical decision support only. Verify calculations with validated external tools. Clinical decisions require qualified healthcare professionals.

⚛ Quantum Healthcare Lab

QSVM Risk Prediction & Simulation Demo

Simulation Mode Active

🧪 QSVM Risk Prediction Demo

Test Quantum Support Vector Machine prediction vs classical methods

Age

TC/HDL Ratio

Systolic BP (mmHg)

Lp(a) (nmol/L)

Smoking

Diabetes

Click "Run QSVM Prediction" to see results

📊 Classical vs Quantum Comparison

Generate batch predictions and compare accuracy metrics

Classical SVM

Accuracy

Quantum SVM

Accuracy

No patients generated yet

🖥 IBM Quantum Access

This project has access to IBM Quantum systems for real quantum execution

127

Qubits

Min/Month

Heron

Processor

⚠ Simulation Mode

Currently running in browser simulation. Real quantum execution requires Python backend with IBM Qiskit Runtime.

📖 How QSVM Works

Feature Encoding

Patient risk factors (age, BP, Lp(a), etc.) are encoded into quantum states using ZZ-Feature Maps

Quantum Kernel

Entanglement captures ALL feature interactions simultaneously, impossible classically

Classification

SVM hyperplane in quantum feature space separates high/low risk with enhanced precision

Research Result: Hybrid quantum models (QGA-QPSO-QSVM) achieved 97.83% accuracy for heart disease prediction in published studies.

📊 Session Metrics

Total Predictions

QSVM Predictions

Classical Predictions

Avg Latency (ms)

Cascade Screenings

👤 Patient Demographics & Basic Information

📋 Basic Information

📏 Anthropometric Measurements

❓ Why BRI over BMI?

🩺 Blood Pressure

⚠️ Risk Factors

💊 Medications & Laboratory Values

Liver Fibrosis Score Interpretation

🔬 Comprehensive ANC Calculator (Marrowforums Reference)

📖 ANC Reference (marrowforums.org)

HOMA-IR Interpretation

💊 Current Medications

⚠️ Drug Interactions Detected

💊 Lipid-Lowering Drug Interaction Checker

📊 Framingham Risk Score Calculator

📋 Risk Factor Inputs (9 Required)

📈 Results

📛 Reference

🇬🇧 QRISK3/QRISK4 Calculator

🔬 Understanding QRISK3 vs QRISK4

📊 Age-Adjusted Risk Modeling

New Factors (All Adults)

Additional Factors (Women Only)

Other QRISK4 Factors

🧮 See Age Impact on Your Selected Conditions

⚖️ QRISK3 vs QRISK4 Comparison

📛 Reference

📈 Combined Risk Assessment & International Scores

🇪🇺 SCORE2 Family (ESC 2021/2023)

🇺🇸 PREVENT Equations (AHA 2024)

✅ Which Calculator Should I Use?

📊 Risk Score Comparison

🫀 Liver Fibrosis & Cardiometabolic Risk Summary

🇪🇺 ESC SCORE2 Family Calculator

💉 SCORE2-Diabetes Additional Inputs

💉 SCORE2-Diabetes Analysis

🇺🇸 AHA PREVENT Calculator (2024)

📊 PREVENT Risk Estimates

💊 Treatment Effect Simulator

📊 Current Risk Profile

💉 Select Treatments to Simulate

📊 Projected Outcomes with Treatment

🔮 What-If Scenario Modeling

📄 Export Complete Report

📋 Treatment Recommendations

⚠️ Important Notice - Educational Tool Only

📋 Treatment Ladder (CCS 2021)

💉 PCSK9 Inhibitor Eligibility (BC PharmaCare Special Authority)

Pathway A: Heterozygous Familial Hypercholesterolemia

Pathway B: Statin Intolerance with Clinical ASCVD

Pathway C: Very High Risk ASCVD

📉 LDL Reduction Planner

💚 Cardiorenal Protection Assessment

🏥 CKD Staging (KDIGO 2024)

📋 CKD Stage Assessment

📉 Kidney Failure Risk Equation (KFRE)

❤️ Cardiorenal Indications

💊 Current Cardiorenal Therapy

💉 GLP-1 RA Therapy

💊 SGLT2 Inhibitor

💊 Statin Therapy

❤️ RAAS Blockade

📋 Cardiorenal Assessment

📚 Quick Reference: Cardiorenal Agents

GLP-1 RA Options (MACE Benefit)

SGLT2i Options (by eGFR)

💊 Medication Dose Adjustment by eGFR (KDIGO 2024)

📋 Dose Recommendation

🏥 Nephrology Referral Criteria (KDIGO 2024)

🚨 Urgent Referral

📋 Routine Referral

🧬 Lipoprotein(a) Assessment

👨 Why This Toolkit Was Created

🔬 Lp(a) Risk Assessment

📛 Key Lp(a) Facts

👨-👩-👧-👪 Family Cascade Screening Calculator

📊 Detailed Impact Analysis

📊 Lp(a) Risk Thresholds

📉 Data Visualizations

📊 Dashboard Overview

👨 Why This Toolkit Was Created

👨-👩-👧-👪 Family Cascade Screening Calculator