Audit: QRS - Combining Pravastatin & Ezetimibe to Lower LDL
Audit conducted on 18/09/2026 01:18 using AI4L / Opus 5
Summary
| Items | Count |
|---|---|
| Total | 93 |
| Passed | 85 |
| Failed | 0 |
| N/A | 8 |
| Pass Rate | 100.00% |
- Total = Passed + Failed + N/A
- Pass Rate = Passed / (Passed + Failed) × 100
- N/A items are excluded from the pass rate calculation
1. General Rules
| # | Description | Result | Comments |
|---|---|---|---|
| 1.1 | Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER. | 🟢 | All protocol, benefit, risk, gate, monitoring and qualitative content traces to ER text; monitoring table and qualitative bullets verified verbatim against ER lines 442–458. |
| 1.2 | Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing. | 🟢 | Cautious framing is carried by tier placement; “Speculative” items (plant sterols, liver fat, gallstones) match the ER’s speculative grading. |
| 1.3 | The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”). | 🟢 | Contraindications carry ER severity unchanged, including “unless rechallenged under specialist supervision” (QRS line 584) mirroring ER line 339. |
| 1.4 | The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc. | 🟢 | Gates draw only from ER Key Interactions & Contraindications; no Benefit- or Risk-Modifying Factor content appears anywhere on the sheet. |
| 1.5 | PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact. | 🟢 | No PMIDs, citations, expert names or NCT identifiers on the sheet; all named agents (cyclosporine, fenofibrate, orlistat, evolocumab, etc.) appear in ER lines 311–331. |
| 1.6 | The QRS does not introduce new attributions. | 🟢 | No attributions present. |
2. Focus, Tone & Audience
| # | Description | Result | Comments |
|---|---|---|---|
| 2.1 | The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing. | 🟢 | Register and British orthography match the ER (“characterised”, “Glycated haemoglobin”). |
| 2.2 | The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging | 🟢 | Declarative, evidence-anchored phrasing throughout. |
| 2.3 | The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor | 🟢 | Facts are stated, not prescribed. |
| 2.4 | The QRS avoids language that implies medical or clinical advice | 🟢 | No “should”, “recommend”, “advise”, “consider” or imperative constructions anywhere in the body. |
| 2.5 | The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising” | 🟢 | Presentational throughout. |
| 2.6 | The QRS never addresses “the reader” directly — it presents evidence, not guidance | 🟢 | No second-person pronouns present. |
| 2.7 | The QRS is written in plain language, avoiding unnecessary medical jargon | 🟢 | Technical terms appear only where the ER’s monitoring markers require them; all are ER-sourced. |
| 2.8 | Information is presented in a concise and very compact manner | 🟢 | Every gate, benefit and risk item is reduced to a bare key fact. |
| 2.9 | It DOES NOT address the reader directly | 🟢 | Confirmed, no direct address. |
| 2.10 | The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review. | 🟢 | Content assumes biomarker tracking and protocol execution. |
| 2.11 | The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort. | 🟢 | Specialty assays (campesterol/sitosterol) and a 9-marker panel are retained. |
| 2.12 | The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort. | 🟢 | Functional rather than conventional reference ranges are used throughout the monitoring table. |
| 2.13 | Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience. | 🟢 | At-a-glance names the borrowed outcome evidence explicitly, matching the ER’s own weighting. |
| 2.14 | The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim. | 🟢 | No “anti-aging” phrasing present. |
| 2.15 | The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “oral” / “administered orally” not “taken by mouth” / “given by mouth”; “injection” not “shot”; “adverse event” not “bad reaction”). This holds on EVERY surface, including the QRS lede — the stricter plain-language bar (see 2.7) does not license lay phrasing for route of administration. Direct quotes from sources are exempt. | 🟢 | Lede opens “Two oral medications” (line 433); no “pill”, “shot” or “by mouth” anywhere. |
3. Template Integrity
| # | Description | Result | Comments |
|---|---|---|---|
| 3.1 | The following labels and headings on the QRS are fixed and not modified: Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment”; Gate headings: “Contraindications”, “Key Interactions”; Tier labels: “High”, “Medium”, “Low”, “Speculative”; Table column headers in Monitoring: “Marker”, “Target”, “Why” | 🟢 | All headings verified against the template at QRS lines 445, 491, 541, 573, 591, 622, 650, 654–656, 806; tier labels intact in all four benefit and four risk spans. |
| 3.2 | All “…” from the [qrs_template] are present in the the QRS. | 🟢 | All 34 template variable names present; marker_#* expanded to rows 1–9 and qualitative_item# to items 1–5 as the template’s repeat pattern intends. |
| 3.3 | Spans that are not addressed in a checklist item are left unchanged | 🟢 | Normalized diff against the template shows no structural or label change beyond the expected removal of the “blank template” comment; the website=”evidence_review”, website=”audit” and website=”full_review” spans are untouched. |
4. Formatting
| # | Description | Result | Comments |
|---|---|---|---|
| 4.1 | When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied” | N/A | No source ER section that feeds the QRS is empty. |
| 4.2 | Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label. | 🟢 | “Standard regimen”, “Relative timing” and “Best time of day” match the ER’s bold labels at lines 361, 363, 365 verbatim. |
| 4.3 | Labels are not paraphrased, abbreviated, or invented. | 🟢 | Protocol labels are verbatim; monitoring row labels match the ER biomarker column exactly. |
| 4.4 | The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels. | 🟢 | No emoji in the file; ER tier emoji and the ⭕️/⚠️ markers are correctly stripped. |
| 4.5 | The QRS is designed to render on one A4 page. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page. | 🟢 | Every list item is reduced to a bare key fact; the print rules and A4 @page block are intact. |
5. Metadata
| # | Description | Result | Comments |
|---|---|---|---|
| 5.1 | The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content. | 🟢 | Lines 2–14, immediately after the doctype. |
| 5.2 | Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML. | 🟢 | Opening “—” at line 3, closing at line 13. |
| 5.3 | The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet. | 🟢 | Enclosed in an HTML comment; no metadata value is echoed in the body. |
| 5.4 | All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting. | 🟢 | Only duration: "00:04" is quoted, correctly so because it contains a colon. |
| 5.5 | The filename of the source ER is stated as “er_filename: [er_filename]” | 🟢 | Line 4. |
| 5.6 | Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]” | 🟢 | Line 5, 26.9.11, matching QRS.md. |
| 5.7 | Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430) | 🟢 | Line 6, 2026-0918-0101. |
| 5.8 | The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]” | 🟢 | Line 7. |
| 5.9 | The nickname of the AI is just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT) | 🟢 | “Opus”. |
| 5.10 | The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]” | 🟢 | Line 8. |
| 5.11 | The full name of the AI consists of the [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4) | 🟢 | “Opus 5”, no qualifier. |
| 5.12 | The filename of the document is stated as “qrs_filename: [filename of this document]” | 🟢 | Line 9, matches the file on disk. |
| 5.13 | All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting. | 🟢 | Re-verified across all eight keys. |
6. Page Title & Header
| # | Description | Result | Comments |
|---|---|---|---|
| 6.1 | [page_title] is set to the [canonical_topic] of the ER frontmatter followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., & for &) |
🟢 | Line 21: “Combining Pravastatin & Ezetimibe to Lower LDL - Quick Reference Sheet”. |
| 6.2 | [header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &) |
🟢 | Line 416, correctly entity-encoded. |
| 6.3 | [header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY] | 🟢 | Line 420: 09/18/2026, from qrs_creation_date 2026-0918-0101. |
| 6.4 | [header_subline_model] is set to [qrs_creator_ai_fullname] | 🟢 | Line 424: “Opus 5”. |
| 6.5 | No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker. | 🟢 | Header holds only the template subline; the ER’s “Also known as” line is correctly omitted. |
7. At-A-Glance Section
| # | Description | Result | Comments |
|---|---|---|---|
| 7.1 | [at_a_glance] is dense, execution-oriented summary of the ER Conclusion section |
🟢 | Maps one-to-one onto ER lines 478–480: dual route, additive effect beyond dose doubling, borrowed outcome evidence, modest harms. |
| 7.2 | [at_a_glance] is no longer than 60 words | 🟢 | 58 words. |
| 7.3 | Every fact in [at_a_glance] is supported by a distinct passage in the ER. | 🟢 | Each of the four sentences traces to a distinct ER Conclusion passage. |
| 7.4 | It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead | 🟢 | No acronyms; “liver production”, “gut absorption”, “the cholesterol that drives artery disease” replace the technical terms. |
| 7.5 | It DOES NOT cite specific trials (names, years, sample sizes, p-values) | 🟢 | No trial named. |
| 7.6 | It DOES NOT cite effect sizes, relative risks, or statistical results | 🟢 | No figures present. |
8. Contraindications
| # | Description | Result | Comments |
|---|---|---|---|
| 8.1 | The section is derived from the ER Key Interactions & Contraindications section |
🟢 | Sourced from the “Populations who should avoid” list at ER lines 335–339. |
| 8.2 | [stop_items] represent the Contraindications from the ER | 🟢 | All five ER entries are present, in ER order. |
| 8.3 | Individual [stop_items] are formatted as <li></li> | 🟢 | Five <li> elements at lines 576–586. |
| 8.4 | Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact. | 🟢 | The trailing clause “where ezetimibe exposure rises three- to sixfold” is correctly stripped from the hepatic impairment item; no dash-trailing content remains. |
| 8.5 | Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely). | 🟢 | “(Child-Pugh Class B or C)” and the “at or above three times the upper limit of normal” threshold are both retained. |
| 8.6 | When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol. | 🟢 | No ranking notation in the ER source; all items are plain prose or comma-separated. |
| 8.7 | The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision. |
🟢 | Section is correctly populated; the ER names five such populations. |
| 8.8 | If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g. | N/A | The section is not empty. |
9. Key Interactions
| # | Description | Result | Comments |
|---|---|---|---|
| 9.1 | The section is derived from the ER Key Interactions & Contraindications section |
🟢 | Sourced from ER lines 311–331. |
| 9.2 | [caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications | 🟢 | All eleven ER interaction bullets are present, in ER order, with no overlap with the Contraindications gate. |
| 9.3 | Individual [caution_items] are formatted as <li></li> | 🟢 | Eleven <li> elements at lines 594–612. |
| 9.4 | Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact. | 🟢 | The ER’s “— caution” / “— monitor” tags and all mechanistic explanation are stripped; only the agent names and their decision-relevant qualifiers remain. |
| 9.5 | Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely). | 🟢 | Example drug lists preserved for fibrates, sequestrants, macrolides, supplements and PCSK9 inhibitors; the 2 h/4 h sequestrant window and the 40 mg bempedoic acid cap are both retained. |
| 9.6 | When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol. | 🟢 | No ranking notation in the ER source; all parenthetical lists are comma-separated. |
| 9.7 | The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used. |
🟢 | Section is correctly populated; the ER names eleven such interactions. |
| 9.8 | If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g. | N/A | The section is not empty. |
10. Protocol
| # | Description | Result | Comments |
|---|---|---|---|
| 10.1 | The section is derived from the ER Protocol section |
🟢 | Sourced from ER Therapeutic Protocol lines 361–365. |
| 10.2 | The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section |
🟢 | Standard regimen, relative timing and best time of day are the three executable bullets; the remaining ER bullets are modifiers rather than actions. |
| 10.3 | If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing. | N/A | The ER supplies more than three actionable aspects; all three sets are used. |
| 10.4 | All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section. |
🟢 | All nine spans carry ER-derived content; no placeholders remain. |
11. Time to Effect
| # | Description | Result | Comments |
|---|---|---|---|
| 11.1 | The three sets of [time] items cover the three most important time-to-effect aspects from the ER | 🟢 | Measurable LDL fall, new steady state and event-level benefit, all from ER line 412. |
| 11.2 | The sets are picked and ordered by the magnitude of the related benefit | 🟢 | All three attach to High-tier benefits (additive LDL reduction and event reduction); the ordering is consistent. |
| 11.3 | If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing. | N/A | The ER supplies three distinct time-to-effect aspects; all three sets are used. |
| 11.4 | All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER. | 🟢 | “2 weeks”, “4–6 weeks” and “Years” match the ER’s stated horizons. |
| 11.5 | If the ER does not provide any information on time to effect, the section is removed completely from the Protocol Panel |
N/A | The ER provides time-to-effect information; the section is correctly retained. |
12. Benefits
| # | Description | Result | Comments |
|---|---|---|---|
| 12.1 | The section is derived from the ER Expected Benefits section |
🟢 | All ten benefit headings from ER lines 147–207 are carried across. |
| 12.2 | Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative] | 🟢 | All four spans present and populated at lines 543–566, matching the ER’s tier assignment exactly. |
| 12.3 | Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact. | 🟢 | Reduced to bare ER headings; no magnitudes, confidence intervals or trial names carried over. |
| 12.4 | Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. | 🟢 | No parentheses in any benefit item. |
| 12.5 | If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing. | N/A | All four tiers carry items in the ER. |
13. Risks
| # | Description | Result | Comments |
|---|---|---|---|
| 13.1 | The section is derived from the ER Potential Risks & Side Effects section |
🟢 | All ten risk headings from ER lines 231–293 are carried across. |
| 13.2 | Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative] | 🟢 | All four spans present and populated at lines 624–644, matching the ER’s tier assignment exactly. |
| 13.3 | Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact. | 🟢 | Reduced to bare ER headings; no odds ratios, event rates or trial names carried over. |
| 13.4 | Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. | 🟢 | No parentheses in any risk item. |
| 13.5 | If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing. | N/A | All four tiers carry items in the ER. |
14. Monitoring
| # | Description | Result | Comments |
|---|---|---|---|
| 14.1 | The section is derived from the ER Monitoring section |
🟢 | Sourced from the ER Monitoring Protocol & Defining Success table at lines 440–450. |
| 14.2 | All measurable/quantifiable biomarkers from the Monitoring section are listed |
🟢 | All nine ER biomarkers present; name, target and rationale strings verified as an exact match to the ER table for every row. |
| 14.3 | [monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER Monitoring section. It is not left with placeholder text or empty. |
🟢 | Line 797 reproduces the ER’s baseline / 8–12 week / 6 month / 6–12 month / annual cadence from ER line 438. |
15. Qualitative Assessment
| # | Description | Result | Comments |
|---|---|---|---|
| 15.1 | The section is derived from the ER Monitoring section |
🟢 | Sourced from the ER’s qualitative marker list at lines 454–458. |
| 15.2 | All subjective/qualitative biomarkers from the Monitoring section are listed |
🟢 | All five ER bullets present and verified as verbatim matches. |
Issues 18/09/2026 01:18
Pass rate 100.00%. No issues found.
Issues 18/09/2026 01:11
- 1.1 — Lipid panel claim at two weeks: [time_1_sub] (QRS lines 503–506) states “The first fall is visible on a lipid panel well before the full effect is reached”, but the ER (line 412) only states LDL “falls measurably within two weeks” and ties the informative follow-up lipid panel to the four-to-six-week steady state.
Fixes 18/09/2026 01:11
- 1.1 — Lipid panel claim at two weeks: Replaced [time_1_sub] “The first fall is visible on a lipid panel well before the full effect is reached.” with “LDL falls measurably within two weeks, well before the new steady state is reached.”, matching the ER wording.
Issues 18/09/2026 01:06
- 11.4 — Time-to-effect subs restate their cells:
time_1_sub(line 503) andtime_3_sub(line 527) only repeat their own label and value (“LDL falls measurably” + “2 weeks” → “LDL falls measurably within two weeks of starting.”; “Event-level benefit” + “Years” → “Event-level benefits accrue over years, not months.”), adding no content the cell does not already carry.
Fixes 18/09/2026 01:06
- 11.4 — Time-to-effect subs restate their cells: Replaced the two subs that echoed their own label and value —
time_1_subnow reads “The first fall is visible on a lipid panel well before the full effect is reached.” andtime_3_subnow reads “Fewer heart attacks and strokes accrue on a decade scale, not alongside the lipid change.”, both drawn from the ER.