The Framingham Risk Score (FRS) estimates 10-year risk of cardiovascular disease. A patient with FRS of 12% and LDL of 145 mg/dL falls in which ACC/AHA risk category and what is the recommended statin intensity?

• A Low risk — no statin needed
• B High risk (>20%) — high-intensity statin mandatory
• C Intermediate risk (7.5–20%) — moderate-intensity statin recommended ✓
• D Borderline risk (5–7.5%) — lifestyle modification only

Explanation

Per ACC/AHA 2018 guidelines, a 10-year ASCVD risk of 7.5–20% is classified as 'intermediate risk,' for which a moderate-intensity statin (e.g., atorvastatin 10–20 mg or rosuvastatin 5–10 mg) is recommended after a risk-benefit discussion. An FRS of 12% falls within the intermediate range. High risk (>20%) warrants high-intensity statin. Risk-enhancing factors can prompt statin initiation at borderline risk (5–7.5%). LDL 145 mg/dL alone does not trigger statin; the cardiovascular risk category guides the decision.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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