This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
What the ASCVD risk estimates
The Pooled Cohort Equations (PCE) were published in 2013 by the American College of Cardiology and the American Heart Association. They estimate the 10-year risk of a first atherosclerotic cardiovascular disease (ASCVD) event: a nonfatal heart attack, death from coronary heart disease, or a fatal or nonfatal stroke. They were built from large US cohorts, including ARIC, the Cardiovascular Health Study, CARDIA and the Framingham studies, with separate equations for white and African American women and men.
Who it applies to
- Adults aged 40 to 79
- With no heart attack, stroke or other ASCVD already
- With an LDL cholesterol under 190 mg/dL (a higher LDL calls for treatment whatever the score)
Like the ACC/AHA online estimator, the calculator keeps total cholesterol between 130 and 320 mg/dL, HDL between 20 and 100 mg/dL and systolic pressure between 90 and 200 mmHg. People of other backgrounds are assessed with the white equations, which may overestimate risk in East Asian people and underestimate it in South Asian people.
Risk categories
| 10-year risk | Category (2018 AHA/ACC cholesterol guideline) |
|---|---|
| Under 5% | Low |
| 5% to 7.4% | Borderline |
| 7.5% to 19.9% | Intermediate |
| 20% or more | High |
For borderline and intermediate risk, guidelines suggest a shared decision about statins that takes risk enhancers into account: a family history of early heart disease, LDL of 160 mg/dL or more, chronic kidney disease, metabolic syndrome, preeclampsia or early menopause, inflammatory diseases such as rheumatoid arthritis or psoriasis, South Asian ancestry, high lipoprotein(a) or a low ankle-brachial index. When the decision is unclear, a coronary artery calcium score can help.
Example
A 55-year-old white man with total cholesterol of 213 mg/dL, HDL of 50 mg/dL and an untreated systolic pressure of 120 mmHg, who does not smoke and has no diabetes, has a 10-year risk of about 5.4%, which is borderline. The second result shows the risk for the same age, sex and race with optimal risk factors.
Limits
The equations tend to overestimate risk in some modern populations. In 2023 the AHA published the PREVENT equations, which drop race and add kidney function, for adults aged 30 to 79. In Europe, doctors use SCORE2 instead.