ASCVD Risk Calculator
Estimate your 10-year risk of a heart attack or stroke (atherosclerotic cardiovascular disease, ASCVD) with the ACC/AHA Pooled Cohort Equations, and see your risk group and your risk with optimal levels.
Results
| Item | Value |
|---|
Quick Answer
The ACC/AHA Pooled Cohort Equations combine age, sex, race, cholesterol, HDL, blood pressure, blood pressure treatment, diabetes and smoking to estimate the chance of a first heart attack or stroke within 10 years. A 55-year-old white man with total cholesterol 213, HDL 50 and an untreated blood pressure of 120, who does not smoke or have diabetes, has a 10-year risk of about 5.4%, which is borderline.
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Table of Contents
- ASCVD Risk Calculator
- Quick Answer
- Related Calculators
- How This ASCVD Risk Calculator Works
- How to Use the ASCVD Risk Calculator
- Pooled Cohort Equations
- Key Terms
- Worked Example
- Real-Life Examples
- 10-Year Risk vs Lifetime Risk
- ASCVD Risk Groups
- What the Risk Number Means
- Common Mistakes to Avoid
- Frequently Asked Questions
- References & Sources
How This ASCVD Risk Calculator Works
Atherosclerotic cardiovascular disease (ASCVD) means heart attacks, deaths from coronary heart disease, and strokes caused by narrowed arteries. US guidelines use a person’s 10-year ASCVD risk to decide how strongly to recommend statins and other prevention. Enter your age, sex, race, cholesterol, HDL, systolic blood pressure, whether you take blood pressure medicine, and whether you have diabetes or smoke. The calculator applies the ACC/AHA Pooled Cohort Equations and shows your 10-year risk, your risk group, and the risk for someone of your age, sex and race with optimal levels.
Quick explanation: the result is the chance, out of 100, of a first heart attack or stroke in the next 10 years.
- Below 5%: low risk.
- 7.5% to 19.9%: intermediate; statins are often discussed.
- 20% or more: high risk.
How to Use the ASCVD Risk Calculator
- Choose your sex and race.
- Enter your age, total cholesterol and HDL cholesterol.
- Enter your systolic (top) blood pressure.
- Choose whether you take blood pressure medicine, have diabetes or smoke.
- Press Calculate and read your 10-year risk and risk group.
Pooled Cohort Equations
- Step 1: take natural logs of age, total cholesterol, HDL and systolic blood pressure
- Step 2: multiply each by its sex- and race-specific coefficient and add them up, including the terms for treatment, smoking and diabetes (for example, white men: 12.344 × ln age + 11.853 × ln TC − 2.664 × ln age × ln TC − 7.990 × ln HDL + 1.769 × ln age × ln HDL + 1.764 × ln SBP (untreated) + 7.837 × smoker − 1.795 × ln age × smoker + 0.658 × diabetes)
- Step 3: 10-year risk = 1 − S10exp(sum − mean)
- Means and baseline survival (S10): white women −29.18 and 0.9665; African American women 86.61 and 0.9533; white men 61.18 and 0.9144; African American men 19.54 and 0.8954
Key Terms
- ASCVD: atherosclerotic cardiovascular disease: heart attack, coronary death or stroke.
- Pooled Cohort Equations: the 2013 ACC/AHA formulas built from five US long-term studies.
- Systolic blood pressure: the top number of a blood pressure reading.
- HDL cholesterol: high-density lipoprotein, the so-called good cholesterol.
- Risk enhancer: a factor such as family history or kidney disease that raises risk beyond the equation.
Worked Example
A 68-year-old white man has total cholesterol 190, HDL 40 and a treated systolic blood pressure of 150, and has diabetes; he does not smoke.
- His sum of coefficient × value terms is compared with the white-male mean of 61.18
- 10-year risk = 1 − 0.9144exp(sum − 61.18) = 43.1%
- That is in the high group
- With optimal levels at age 68 his risk would be 11.2%, so most of his risk comes from age
Real-Life Examples
- Before a check-up: a 55-year-old white man with average numbers has about 5.4% risk.
- Higher-risk profile: a 62-year-old African American woman with cholesterol 230, HDL 45, treated blood pressure 145, who smokes, has about 24.5% risk.
- See the effect of quitting: change smoking to No and compare.
- Compare with optimal: the optimal-levels row shows how much risk you could lower.
10-Year Risk vs Lifetime Risk
- 10-year risk is the chance of an event in the next 10 years; it is driven mostly by age.
- Lifetime risk is the chance over the rest of life; younger adults with high cholesterol can have low 10-year but high lifetime risk.
- Both help decide how early to start prevention.
ASCVD Risk Groups
Treatment decisions are made with a clinician.
| 10-year risk | Group | Usual next step |
|---|---|---|
| Below 5% | Low | Healthy lifestyle |
| 5% to 7.4% | Borderline | Lifestyle; statin may be discussed if risk enhancers are present |
| 7.5% to 19.9% | Intermediate | Discuss a moderate-intensity statin; consider a calcium score |
| 20% or more | High | Discuss a high-intensity statin |
What the Risk Number Means
Age is the strongest factor: risk rises steeply with every decade, so even people with perfect numbers reach intermediate risk in their late 60s and 70s. Smoking, diabetes, high blood pressure and low HDL each add a lot of risk; quitting smoking and controlling blood pressure lower it. Cholesterol matters most over many years.
The 2019 ACC/AHA primary prevention guideline uses the 10-year risk to guide a discussion between patient and clinician, together with risk enhancers such as family history of early heart disease, chronic kidney disease, metabolic syndrome, inflammatory diseases, high lipoprotein(a) or a high coronary artery calcium score. People who already have heart disease or stroke, or who have LDL of 190 mg/dL or more, are treated without this calculator. Studies have found that the equations can overestimate risk in some modern populations, and the American Heart Association released the newer PREVENT equations in 2023.
Common Mistakes to Avoid
- Using it after a heart attack or stroke. The equations are only for people without ASCVD.
- Entering diastolic pressure. Use the top (systolic) number.
- Entering cholesterol in mmol/L. Multiply by 38.67 to get mg/dL.
- Forgetting treatment. Treated blood pressure carries more risk than the same untreated value.
- Reading it as a diagnosis. It is a population estimate, not a prediction for one person.
Frequently Asked Questions
Below 5% over 10 years is low risk; 7.5% or more is the level where statins are often discussed.
With the 2013 ACC/AHA Pooled Cohort Equations, which use age, sex, race, cholesterol, HDL, blood pressure, treatment, diabetes and smoking.
Adults aged 40 to 79.
The equations were fitted separately for white and African American adults from US cohorts.
Guidelines suggest discussing a statin at 7.5% or higher, and sometimes at 5% to 7.4% with risk enhancers.
Yes: stopping smoking, lowering blood pressure and cholesterol, and managing diabetes all lower it.
It is useful for groups but can overestimate risk in some modern populations.
A newer AHA model from 2023 that adds kidney function and does not use race.
No. It uses total and HDL cholesterol; LDL of 190 or more is treated without it.
References & Sources
| Source | Used For | Link |
|---|---|---|
| Goff DC Jr et al. (2014), 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk | Circulation 129(25 Suppl 2):S49-S73. Pooled Cohort Equations, Table A. | https://www.ahajournals.org/doi/10.1161/01.cir.0000437741.48606.98 |
| Arnett DK et al. (2019), ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease | Circulation 140:e596-e646. Risk groups and statin discussion. | https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678 |