Which of the following is a qualifying characteristic for initiating moderate- to high-intensity statin therapy without calculating 10-year ASCVD risk?

• A. Diabetes mellitus
• B. Family history of coronary disease
• C. Age over 75
• D. Current smokers

Answer: (A)

Having diabetes is a qualifying condition for starting moderate- to high-intensity statin therapy without calculating 10-year ASCVD risk. In adults aged 40–75, diabetes itself places enough baseline risk that the guidelines recommend initiating statin therapy to reduce future cardiovascular events, even if the ASCVD risk calculation would suggest a lower risk. This reflects solid evidence that statins provide clear benefit in people with diabetes.

Other factors listed don’t automatically trigger treatment without risk assessment. A family history of coronary disease influences risk, but it isn’t a standalone criterion to bypass risk calculation. Being over 75 changes the approach and generally requires individualized decision-making rather than an automatic push to high-intensity therapy without risk assessment. Current smoking increases risk, but by itself it doesn’t establish an automatic threshold to start moderate- to high-intensity statins without risk calculation.