ASCVD Risk Calculator
Calculate 10-year atherosclerotic cardiovascular disease (ASCVD) risk using the Pooled Cohort Equations. Guides statin therapy and primary prevention decisions.
10-Year ASCVD Risk
5.7%
Borderline Risk
Consider risk-enhancing factors. Shared decision-making about moderate-intensity statin therapy.
Optimal 10-Year Risk
3.6%
Estimated Lifetime Risk
~45%
Risk Categories & Statin Guidelines
| 10-Year Risk | Category | Statin Recommendation |
|---|---|---|
| <5% | Low | Generally not indicated |
| 5-7.5% | Borderline | Consider if risk-enhancers present |
| 7.5-20% | Intermediate | Moderate-high intensity |
| ≥20% | High | High-intensity recommended |
Risk-Enhancing Factors (Not in Calculator)
- • Family history of premature ASCVD
- • LDL-C ≥160 mg/dL
- • Metabolic syndrome
- • Chronic kidney disease
- • Chronic inflammatory conditions
- • South Asian ancestry
- • Elevated Lp(a)
- • Elevated hs-CRP ≥2 mg/L
Disclaimer: This calculator is for educational purposes only. Treatment decisions should be made with a healthcare provider considering individual circumstances, risk-enhancing factors, and patient preferences.
Related Calculators
About This Calculator
The ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator estimates your 10-year risk of having a heart attack or stroke. Based on the Pooled Cohort Equations developed by the American College of Cardiology and American Heart Association, this tool helps guide decisions about statin therapy and lifestyle modifications for primary prevention.
What is ASCVD? Atherosclerotic cardiovascular disease includes conditions caused by plaque buildup in arteries: coronary heart disease, stroke, and peripheral artery disease. It's the leading cause of death worldwide, but many events are preventable through risk factor modification.
What the Calculator Measures: The 10-year risk represents your probability of having a first cardiovascular event (heart attack, stroke, or related death) in the next decade. This guides primary prevention strategies.
Key Risk Factors:
- Age (risk increases significantly)
- Sex (men have higher risk until late in life)
- Race (different equations for different populations)
- Total cholesterol and HDL cholesterol
- Blood pressure (and treatment status)
- Diabetes
- Smoking status
For related cardiovascular assessments, see our CHA₂DS₂-VASc Calculator for atrial fibrillation stroke risk.
How to Use the ASCVD Risk Calculator
- 1Enter your age (valid for ages 40-79).
- 2Select biological sex and race/ethnicity.
- 3Enter your total cholesterol level (mg/dL).
- 4Enter your HDL (good) cholesterol level (mg/dL).
- 5Enter your systolic blood pressure (top number).
- 6Indicate if you're taking blood pressure medications.
- 7Indicate diabetes status (Type 1 or Type 2).
- 8Indicate current smoking status.
- 9Review your 10-year ASCVD risk percentage.
- 10Discuss results and treatment options with your doctor.
Understanding Your Risk
What the ASCVD risk percentage means.
Risk Categories
| 10-Year Risk | Category | Typical Approach |
|---|---|---|
| <5% | Low | Lifestyle focus |
| 5-7.5% | Borderline | Consider risk enhancers |
| 7.5-20% | Intermediate | Statin consideration |
| ≥20% | High | Statin strongly recommended |
What the Number Means
A 10% risk means: Out of 100 similar people, about 10 would be expected to have a cardiovascular event in the next 10 years.
Primary vs. Secondary Prevention
Primary prevention (this calculator): For people who have NOT yet had a heart attack or stroke.
Secondary prevention: For people who HAVE had an event—they need aggressive treatment regardless of calculated risk.
Risk vs. Guarantee
Risk is probabilistic:
- Some low-risk people will have events
- Some high-risk people won't
- Risk assessment helps target interventions
The Pooled Cohort Equations
The science behind the calculator.
Development
The equations were developed from multiple large cohort studies:
- ARIC (Atherosclerosis Risk in Communities)
- CHS (Cardiovascular Health Study)
- CARDIA
- Framingham Heart Study
Total: ~25,000 participants followed for years.
Separate Equations
Four different equations based on:
- White men
- White women
- African American men
- African American women
"Other" races use the white equations.
Variables Included
Age: Single strongest predictor Sex: Men have higher risk Race: African Americans have different risk profiles Total Cholesterol: Higher = worse HDL Cholesterol: Higher = better Systolic BP: Higher = worse (treated BP still counts) Diabetes: Significant risk multiplier Smoking: Major modifiable risk factor
What's NOT Included
- Family history
- LDL cholesterol specifically
- Triglycerides
- Diet/exercise
- Obesity/BMI
- Inflammatory markers (hs-CRP)
These are considered "risk enhancers" used in clinical judgment.
Statin Treatment Guidelines
How risk guides medication decisions.
2018 ACC/AHA Cholesterol Guidelines
High-Intensity Statin (LDL reduction ≥50%):
- Atorvastatin 40-80 mg
- Rosuvastatin 20-40 mg
Moderate-Intensity Statin (LDL reduction 30-49%):
- Atorvastatin 10-20 mg
- Rosuvastatin 5-10 mg
- Simvastatin 20-40 mg
- Pravastatin 40-80 mg
Risk-Based Recommendations
≥20% risk (High): Start high-intensity statin therapy.
7.5-20% risk (Intermediate): Discuss moderate-to-high intensity statin. Consider coronary artery calcium (CAC) scoring.
5-7.5% risk (Borderline): If risk enhancers present, consider statin.
<5% risk (Low): Focus on lifestyle. Statin usually not indicated.
The CAC Score Option
For intermediate risk patients:
- CAC = 0: Very low event rate, may defer statin
- CAC = 1-99: Favors statin therapy
- CAC ≥100: Strong indication for statin
Risk-Enhancing Factors
Additional factors to consider beyond the calculator.
Family History
Premature ASCVD in first-degree relative:
- Men <55 years
- Women <65 years
Strong predictor not in the equation.
Metabolic Factors
- LDL-C persistently ≥160 mg/dL
- Metabolic syndrome
- Elevated triglycerides (≥175 mg/dL)
- Elevated apoB (≥130 mg/dL)
- Elevated Lp(a) (≥50 mg/dL)
- Elevated hs-CRP (≥2 mg/L)
Specific Conditions
- Chronic kidney disease
- Chronic inflammatory conditions (RA, lupus, HIV)
- History of preeclampsia
- History of premature menopause (<40 years)
- South Asian ancestry
Subclinical Disease
- Coronary artery calcium (CAC) score
- Ankle-brachial index (ABI) <0.9
- Carotid plaque on ultrasound
How Risk Enhancers Are Used
If your calculated risk is borderline or intermediate, presence of risk enhancers tips the decision toward treatment.
Lifestyle Modifications
Non-medication strategies to reduce risk.
Diet
Heart-healthy patterns:
- Mediterranean diet
- DASH diet
- Plant-based diets
Specific recommendations:
- Increase fruits, vegetables, whole grains
- Limit saturated fat (<6% of calories)
- Minimize trans fats (eliminate if possible)
- Reduce sodium (<2,300 mg/day)
- Moderate alcohol (if any)
Exercise
Goal: At least 150 minutes/week moderate-intensity or 75 minutes/week vigorous aerobic activity.
Benefits:
- Raises HDL
- Lowers blood pressure
- Improves insulin sensitivity
- Reduces weight
- Direct cardiovascular benefits
Smoking Cessation
The single most impactful change for smokers:
- Risk drops significantly within 1-2 years
- Approaches non-smoker levels by 5-15 years
- Any quit method is helpful
Weight Management
Losing 5-10% of body weight can:
- Lower LDL and triglycerides
- Raise HDL
- Reduce blood pressure
- Improve diabetes control
Blood Pressure Control
Target: <130/80 mmHg for most adults Every 10 mmHg reduction in SBP significantly reduces events.
Limitations and Controversies
Important considerations about the calculator.
Known Limitations
May overestimate risk in:
- Some ethnic groups (Hispanics, Asian Americans)
- People with healthier lifestyles
- Those from contemporary populations (healthier than derivation cohorts)
May underestimate risk in:
- South Asians
- People with strong family history
- Those with chronic inflammatory conditions
- Young people with severe risk factors
Missing Risk Factors
The equations don't include:
- Family history
- Obesity/BMI
- Diet quality
- Exercise level
- Triglycerides
- Inflammatory markers
- Stress/mental health
The Recalibration Debate
Some argue equations need updating because:
- Derived from older cohorts (1990s)
- Populations are healthier now
- May lead to over-treatment
Counter-argument:
- Still validated in recent populations
- Benefits of statins are well-established
- Risk enhancers add clinical judgment
Shared Decision-Making
The calculator is a tool, not a mandate:
- Discuss benefits and risks of therapy
- Consider patient preferences
- Factor in medication tolerability
- Review periodically
Pro Tips
- 💡Valid for ages 40-79; under 40 requires different assessment.
- 💡10-year risk ≥7.5% generally indicates statin consideration.
- 💡Family history isn't in the calculator but matters clinically.
- 💡CAC scoring helps clarify intermediate-risk decisions.
- 💡Smoking cessation is the most impactful lifestyle change.
- 💡Risk is probabilistic, not a guarantee of outcome.
- 💡Recalculate when major risk factors change.
- 💡Discuss "risk enhancers" with your doctor.
- 💡The calculator is for PRIMARY prevention only.
- 💡Lifestyle modifications benefit everyone, regardless of risk level.
- 💡Aspirin is no longer routinely recommended for primary prevention.
- 💡Shared decision-making should guide treatment choices.
Frequently Asked Questions
Age is the strongest risk factor—even healthy older adults have elevated scores. Also, many conditions (diabetes, hypertension) add risk even when well-controlled. The calculator reflects population-level statistics; individual outcomes vary.
