What is considered high ASCVD risk?

A 10-year ASCVD risk ≥ 20% is considered high risk. Risk categories are: low (< 5%), borderline (5–7.4%), intermediate (7.5–19.9%), and high (≥ 20%). The ACC/AHA guidelines recommend statin therapy for patients with 10-year risk ≥ 7.5% after shared decision-making.

What are the limitations of the ASCVD risk calculator?

The Pooled Cohort Equations may overestimate risk in some populations and underestimate risk in others. They were developed from predominantly US cohorts and may not apply well to other populations. They do not account for family history, inflammatory markers, or coronary artery calcium scores, which can reclassify risk.

When should ASCVD risk be calculated?

ASCVD risk should be assessed in adults aged 40–75 without existing cardiovascular disease to guide primary prevention decisions, particularly statin therapy initiation. It should be recalculated every 4–6 years or when risk factors change significantly.

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ASCVD Risk Calculator

Estimate 10-year risk of atherosclerotic cardiovascular disease using the ACC/AHA Pooled Cohort Equations (PCE). For adults 40–79 without known ASCVD.

Inputs

Age (40–79)

Sex

Race

Total Cholesterol (mg/dL)

HDL Cholesterol (mg/dL)

Systolic BP (mmHg)

On blood pressure treatment?

Diabetes?

Current smoker?

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Enter all fields to calculate 10-year ASCVD risk.

Low< 5%

Borderline5–7.4%

Intermediate7.5–19.9%

High≥ 20%

Statin guidance (2018 ACC/AHA): Consider moderate-intensity statin if risk 7.5–19.9%. Recommend high-intensity statin if risk ≥ 20% or LDL ≥ 190 mg/dL. Use risk-enhancing factors and CAC scoring for borderline/intermediate risk discussions.

Disclaimer: For educational purposes only. Not a substitute for clinical judgment.

When to use

Use this calculator for primary prevention risk assessment in adults aged 40–79 without known ASCVD, to guide shared decision-making about statin therapy and lifestyle modification.

Clinical pearls

The PCE was validated in White and African American populations; may overestimate risk in other groups.
Risk-enhancing factors (family history, CRP ≥ 2, ABI < 0.9, etc.) can upgrade risk category.
Coronary artery calcium (CAC) score of 0 can reclassify borderline/intermediate risk downward.
Not for use in patients with known ASCVD — those patients are already high risk for secondary prevention.

References

Goff DC Jr, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation. 2014;129(25 Suppl 2):S49-S73.
Grundy SM, et al. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082-e1143.

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About This Tool

What Is the ASCVD Risk Calculator?

The Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator estimates the 10-year probability of a first atherosclerotic cardiovascular event — defined as nonfatal myocardial infarction, coronary heart disease death, or fatal/nonfatal stroke. It uses the Pooled Cohort Equations (PCE) developed by the ACC/AHA from multiple large US cohort studies including the Framingham Heart Study, ARIC, CARDIA, and CHS. The calculator is intended for adults aged 40–79 years without pre-existing ASCVD.

How It Works

The PCE uses age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure treatment status, diabetes, and smoking status as inputs. Sex- and race-specific Cox proportional hazards regression coefficients are applied to calculate the 10-year event probability. The equations produce separate models for White males, White females, African American males, and African American females. For other racial/ethnic groups, the White equations are generally applied, though this may overestimate risk in some populations (e.g., Hispanic and East Asian groups).

Using ASCVD Risk in Clinical Practice

The 2018 ACC/AHA cholesterol guidelines use ASCVD risk to guide statin therapy decisions. For patients with 10-year risk ≥ 20%, high-intensity statins are recommended. For intermediate risk (7.5–19.9%), moderate-intensity statins should be considered after shared decision-making. For borderline risk (5–7.4%), risk-enhancing factors such as family history, elevated CRP, or ethnic-specific risk may favor therapy. Coronary artery calcium (CAC) scoring is recommended when risk-based decisions are uncertain.

🔑 Clinical Pearls

The PCE may overestimate risk in populations not well represented in derivation cohorts — consider recalibration or additional markers.
A CAC score of 0 in low-intermediate risk patients has a strong negative predictive value and may defer statin initiation.
Risk-enhancing factors: family history of premature ASCVD, LDL ≥ 160 mg/dL, metabolic syndrome, CKD, chronic inflammatory conditions, South Asian ancestry, hsCRP ≥ 2 mg/L.
Lifetime risk estimation can motivate younger patients with low 10-year risk but unfavorable risk factor profiles.

Key References

Goff DC Jr, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation. 2014;129(25 Suppl 2):S49-S73.
Grundy SM, et al. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082-e1143.
Muntner P, et al. Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations. JAMA. 2014;311(14):1406-1415.

Formula last verified: February 2026