Risk enhancers and modifiers

Lists the factors that move a primary-prevention patient up or down from the PREVENT or SCORE2 estimate: the ACC/AHA 2026 risk-enhancing factors (Lp(a) ≥ 125 nmol/L or 50 mg/dL, apoB ≥ 120 mg/dL, hs-CRP ≥ 2 mg/L on more than one occasion, LDL-C 160–189 mg/dL, raised triglycerides, premature family history, chronic inflammatory disease, CKD, female-specific factors, ancestry, ABI < 0.9) and the ESC risk modifiers (Lp(a) > 50 mg/dL, persistent hs-CRP > 2 mg/L, carotid or femoral plaque, inflammatory disease, HIV, psychiatric disorders, social deprivation). It combines them with the baseline category into a statin decision for each guideline and says when to measure Lp(a), apoB and hs-CRP, and when to use Doppler ultrasound or CAC. No 2026 ESC lipid or prevention guideline has been published; the ESC side follows the 2025 ESC/EAS focused update and the 2021 prevention guideline.