ASCVD Risk Calculator
Calculates 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the ACC/AHA Pooled Cohort Equations to guide statin therapy decisions.
Patient Information
Equations validated for White and African American populations
Valid for ages 40-79 years
Important
This calculator is for primary prevention only. Do not use for patients with established ASCVD (prior MI, stroke, PAD, or coronary revascularization).
10-Year ASCVD Risk
Enter values to calculate
About This Calculator
The ASCVD Risk Calculator uses the Pooled Cohort Equations (PCE) developed by the American College of Cardiology (ACC) and American Heart Association (AHA) in 2013. It estimates the 10-year risk of a first "hard" ASCVD event, including: • Non-fatal myocardial infarction • Coronary heart disease death • Non-fatal or fatal stroke
The equations were derived from multiple large population-based cohorts including ARIC, CHS, CARDIA, and Framingham studies, providing sex- and race-specific risk estimates for adults aged 40-79 years.
The 2018/2019 ACC/AHA guidelines recommend using this calculator to guide shared decision-making about statin therapy for primary prevention. Risk thresholds help determine intensity of preventive interventions.
Note: The equations were validated in White and African American populations. For other racial/ethnic groups, White coefficients are used with the understanding that further research is needed.
Formula
Risk = 1 - S₀^exp(ΣβᵢXᵢ - Mean Coef) where S₀ is baseline survival and β are race/sex-specific coefficientsThe Pooled Cohort Equations use Cox proportional hazards regression with sex- and race-specific coefficients for: • Log-transformed age • Log-transformed total cholesterol • Log-transformed HDL cholesterol • Log-transformed systolic blood pressure (separate coefficients for treated/untreated) • Age × cholesterol interaction terms • Diabetes (binary) • Current smoking (binary) The 10-year risk is calculated using baseline survival rates and mean coefficient values derived from the original cohort studies.
Clinical Considerations
- •This calculator is for primary prevention only (no prior ASCVD events)
- •Valid for adults aged 40-79 years
- •Validated in White and African American populations; use with caution in other groups
- •May overestimate risk in some contemporary populations
- •Does not account for all risk factors (family history, CRP, CAC score)
- •Clinical judgment should guide therapy decisions
Limitations
- •Derived from cohorts in the pre-statin era
- •May overestimate risk by ~20% in some populations
- •Limited validation in Hispanic, Asian, and other racial groups
- •Does not include newer risk markers (Lp(a), hsCRP, CAC)
- •Static estimate that may not reflect risk trajectory
- •Consider using risk-enhancing factors for borderline cases
Interpretation Guide
| Range | Classification | Recommendation |
|---|---|---|
| <-5 | Low Risk | Low 10-year ASCVD risk. Emphasize lifestyle modifications including healthy diet, regular physical activity, and avoiding tobacco. Statin therapy generally not recommended for primary prevention at this risk level. |
| 5-7.5 | Borderline Risk | Borderline risk. If risk-enhancing factors are present, consider moderate-intensity statin therapy. Emphasize lifestyle modifications. Shared decision-making recommended. |
| 7.5-20 | Intermediate Risk | Intermediate risk. Moderate-intensity statin therapy is recommended to reduce LDL-C by 30-49%. Consider coronary artery calcium (CAC) scoring if decision is uncertain. |
| 20-100 | High Risk | High risk. High-intensity statin therapy is recommended to reduce LDL-C by ≥50%. Consider additional LDL-lowering therapy if LDL-C remains ≥70 mg/dL on maximally tolerated statin. |
Frequently Asked Questions
What is the ASCVD Risk Calculator?
The ASCVD Risk Calculator estimates your 10-year risk of having a first cardiovascular event (heart attack or stroke). It uses the Pooled Cohort Equations developed by the ACC/AHA and helps guide decisions about statin therapy for primary prevention.
What ASCVD risk level requires statin therapy?
According to 2018/2019 ACC/AHA guidelines: For 10-year risk ≥20% (high), high-intensity statin is recommended. For 7.5-20% (intermediate), moderate-intensity statin is recommended. For 5-7.5% (borderline), statin may be considered if risk-enhancing factors are present.
What are risk-enhancing factors?
Risk-enhancing factors include: family history of premature ASCVD, LDL-C ≥160 mg/dL, metabolic syndrome, chronic kidney disease, chronic inflammatory conditions (e.g., rheumatoid arthritis, psoriasis), South Asian ancestry, elevated Lp(a), elevated triglycerides, and elevated hsCRP.
Should I get a coronary calcium (CAC) score?
CAC scoring can be helpful when the decision about statin therapy is uncertain, particularly for those with borderline or intermediate risk. A CAC of 0 suggests very low risk, while CAC ≥100 or ≥75th percentile suggests higher risk warranting statin therapy.
How accurate is this calculator?
The Pooled Cohort Equations have been shown to overestimate risk by approximately 20% in some contemporary populations. However, they remain the recommended tool per ACC/AHA guidelines. The newer PREVENT equations may provide more accurate estimates but are not yet widely adopted.
References
1. Goff DC Jr, Lloyd-Jones DM, Bennett G, et al.. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation. 2014. doi: 10.1161/01.cir.0000437741.48606.98
View Source →2. Grundy SM, Stone NJ, Bailey AL, et al.. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2019. doi: 10.1161/CIR.0000000000000625
View Source →3. Arnett DK, Blumenthal RS, Fonarow GC, et al.. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019. doi: 10.1161/CIR.0000000000000678
View Source →Last updated: 2025-01-15
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