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Instructions

Apply to asymptomatic adults aged 40–75 years with LDL-C 70–189 mg/dL (1.81-4.90 mmol/L) without known ASCVD when considering primary prevention interventions, particularly statin therapy.
Refrain from using in:
- Adults <40 or >75 years of age (limited data on performance).
- Patients with known ASCVD.
- Adults with LDL-C ≥190 mg/dL, including familial hypercholesterolemia (lipid-lowering therapy is indicated regardless of calculated risk).
Treatment thresholds based on this tool are historical, as 2026 ACC/AHA dyslipidemia guidelines now recommend PREVENT for primary prevention risk assessment.
PREVENT provides risk estimates approximately 40%–50% lower than the 2013 ASCVD Risk Score for the same risk factor profile, with correspondingly adjusted treatment thresholds (≥3% for PREVENT vs ≥5% for the 2013 ASCVD Risk Score).

Age

This calculator only applies to individuals 40-75 years of age.

Min 40 – Max 75

Introduction

Estimates the 10-year risk of a first hard atherosclerotic cardiovascular disease event (nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke) in adults 40 to 7 years of age without clinical ASCVD, using the race- and sex-specific Pooled Cohort Equations from the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk (Goff et al., 2014) found in Appendix 7. This tool includes the optional additional risk markers (family history of premature CVD, hs-CRP, coronary artery calcium, ankle-brachial index) for use when a risk-based treatment decision remains uncertain.

Apply to asymptomatic adults aged 40–75 years with LDL-C 70–189 mg/dL (1.81-4.90 mmol/L) without known ASCVD when considering primary prevention interventions, particularly statin therapy.
Refrain from using in:
- Adults <40 or >75 years of age (limited data on performance).
- Patients with known ASCVD.
- Adults with LDL-C ≥190 mg/dL, including familial hypercholesterolemia (lipid-lowering therapy is indicated regardless of calculated risk).

ASCVD Risk Calculator (2013 ACC/AHA Pooled Cohort Equations)

The 2013 ASCVD Risk Calculator estimates a person's 10-year risk of a first atherosclerotic cardiovascular event, and it was the standard tool for guiding statin decisions in primary prevention for over a decade. It has since been superseded. The March 2026 ACC/AHA dyslipidemia guideline replaced the Pooled Cohort Equations with the PREVENT-ASCVD equations.

Development

The Pooled Cohort Equations were published in 2013 by an ACC/AHA work group (Goff et al., 2014). They pool four major US cohorts (ARIC, CHS, CARDIA, and Framingham) to produce sex- and race-specific Cox proportional-hazards equations. They were built to identify appropriate candidates for statin therapy and were proposed as a replacement for the Framingham 10-year risk calculation recommended in earlier NCEP ATP III guidelines.

What It Predicts

The outcome is a first "hard" ASCVD event: nonfatal myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke. The tool is for primary prevention only and gives a 10-year risk. Not intended for patients with existing ASCVD.

Inputs

The model requires age, sex, race, total cholesterol, HDL-C, systolic blood pressure, blood pressure treatment, smoking status, and diabetes. Entry ranges included:

Input	Accepted range
Age	40–75 years
Total cholesterol	130–320 mg/dL
HDL-C	20–100 mg/dL
Systolic BP	90–200 mmHg

Total cholesterol and HDL cholesterol can be entered as either mg/dL or mmol/L.

Race is entered as White or African American, with other groups conventionally scored using the White equations. Each sex-and-race group has its own equation. Each takes the form 1 − S₀^exp(Σβx − mean), where S₀ is the baseline 10-year survival for that group, β are the coefficients, and several continuous inputs are log-transformed.

Scoring

Scoring source information is available in Appendix 7 in the Goff, et al. 2014 study. Refer to the EVAL builder for the sex- and race-specific Cox proportional-hazards equations used for this tool.

Result Options

10-year ASCVD risk <5%:

No statin recommended because 10-year risk <5%;
Encourage lifestyle modification
Reassess risk factors every 4-6 years
Some patients with other high risk features may still be appropriate for treatment. Refer to published guidelines below.

10-year ASCVD risk 5% to <7.5%:

Evaluate risk-enhancing factors.
Consider moderate-intensity statin therapy if risk enhancers present. refer to published guidelines below.
May use coronary artery calcium (CAC) scoring to refine the treatment decision.
Follow-up:
- Reassess lipids 4–12 weeks after statin initiation or dose adjustment.
- Repeat every 3–12 months as needed.
- Assess adherence and percentage LDL-C reduction from baseline.

10-year ASCVD risk ≥7.5%

Consider initiating moderate- or high-intensity statin therapy after clinician-patient discussion. Refer to published guidelines below.
If 10-year risk ≥20%: Consider high-intensity statin to reduce LDL-C ≥50%.
If 10-year risk 7.5%–19.9%: Consider moderate-intensity statin to reduce LDL-C ≥30%.
Follow-up:
- Reassess lipids 4–12 weeks after statin initiation or dose adjustment.
- Repeat every 3–12 months as needed.
- Assess adherence and percentage LDL-C reduction from baseline.

Additional Risk Markers Supporting Upward Revision (optional)

Number of the optional markers recorded (family history of premature CVD, hs-CRP, coronary artery calcium, ankle-brachial index) that fall in the range the guideline describes as supporting revising the risk assessment upward.

Management Considerations

Treatment thresholds based on this tool are historical, as ACC/AHA dyslipidemia guidelines now recommend PREVENT for primary prevention risk assessment. If this tool is used, the following may be considered:
Interpret results of this tool within the clinical context, and consider the following during the clinician-patient discussion:
1. Absolute risk estimate.
2. Net benefit of therapy.
3. Socioeconomic status.
4. Patient preferences and values.
5. Risk-enhancing factors, including:
  1. Family history of premature ASCVD.
  2. Persistently elevated LDL-C ≥160 mg/dL.
  3. Metabolic syndrome.
  4. Chronic kidney disease.
  5. History of preeclampsia or premature menopause (age <40 years).
  6. Chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, HIV).
  7. High-risk ethnicity (e.g., South Asian ancestry).
  8. Persistent triglyceride elevation ≥175 mg/dL.
6. Supporting studies, when available:
  1. Apolipoprotein B ≥130 mg/dL.
  2. hs-CRP ≥2.0 mg/L.
  3. Ankle-brachial index (ABI) <0.9.
  4. Lipoprotein(a) ≥50 mg/dL.

Clinical Guidelines

US Preventive Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.
Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology.

All questions & possible results

Risk FactorsTitle not visible

Age

This calculator only applies to individuals 40-75 years of age.

A number between 40 and 75 (whole numbers), in years.

Sex

Select one option:

Male
Female

Race

Select one option:

White / Other
African American

Total cholesterol

Normal range:

150-200 mg/dL
3.9-5.2 mmol/L

A number between 50 and 500, in mg/dL or mmol/L.

HDL cholesterol

Normal range:

60-155 mg/dL
1.55-4.01 mmol/L

A number between 0 and 150, in mg/dL or mmol/L.

Systolic blood pressure

Normal range: 100-120 mmHg

A number between 60 and 250, in mmHg.

Treatment for hypertension

Select one option:

Current smoker

Select one option:

Diabetes mellitus

Select one option:

Additional Risk Markers

The guideline suggests these markers may be considered only when, after quantitative risk assessment, a risk-based treatment decision remains uncertain. They are optional.

Family history of premature cardiovascular disease (first-degree relative: male <55 years, female <65 years)

Select one option:

Occurrences at older ages only, or absent (does not support revising upward)
Present (supports revising risk assessment upward)

High-sensitivity C-reactive protein (hs-CRP) level

Select one option:

<2 mg/L (does not support revising upward)
≥2 mg/L (supports revising risk assessment upward)

Coronary artery calcium (CAC) score

Select one option:

<300 Agatston units and <75th percentile for age, sex, and ethnicity (does not support revising upward)
≥300 Agatston units or ≥75th percentile for age, sex, and ethnicity (supports revising upward)

Ankle-brachial index (ABI)

Select one option:

≥0.9 (does not support revising upward)
<0.9 (supports revising risk assessment upward)

Possible results

Risk of cardiovascular event (coronary or stroke death or non-fatal MI or stroke) in next 10 years (5% to <7.5%)

Treatment thresholds based on this tool are historical, as ACC/AHA dyslipidemia guidelines now recommend PREVENT for primary prevention risk assessment. If this tool is used, the following may be considered:

Evaluate risk-enhancing factors.
Consider moderate-intensity statin therapy if risk enhancers present. refer to published guidelines below.
May use coronary artery calcium (CAC) scoring to refine the treatment decision.
Follow-up:
- Reassess lipids 4–12 weeks after statin initiation or dose adjustment.
- Repeat every 3–12 months as needed.
- Assess adherence and percentage LDL-C reduction from baseline.

Considersations

Interpret results of this tool within the clinical context, and consider the following during the clinician-patient discussion:

Absolute risk estimate.
Net benefit of therapy.
Socioeconomic status.
Patient preferences and values.
Risk-enhancing factors, including:
- Family history of premature ASCVD.
- Persistently elevated LDL-C ≥160 mg/dL.
- Metabolic syndrome.
- Chronic kidney disease.
- History of preeclampsia or premature menopause (age <40 years).
- Chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, HIV).
- High-risk ethnicity (e.g., South Asian ancestry).
- Persistent triglyceride elevation ≥175 mg/dL.
Supporting studies, when available:
- Apolipoprotein B ≥130 mg/dL.
- hs-CRP ≥2.0 mg/L.
- Ankle-brachial index (ABI) <0.9.
- Lipoprotein(a) ≥50 mg/dL.

Clinical Guidelines

US Preventive Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.
Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology.

Risk of cardiovascular event (coronary or stroke death or non-fatal MI or stroke) in next 10 years (≥7.5%)

Consider initiating moderate- or high-intensity statin therapy after clinician-patient discussion. Refer to published guidelines below.
If 10-year risk ≥20%: Consider high-intensity statin to reduce LDL-C ≥50%.
If 10-year risk 7.5%–19.9%: Consider moderate-intensity statin to reduce LDL-C ≥30%.
Follow-up:
- Reassess lipids 4–12 weeks after statin initiation or dose adjustment.
- Repeat every 3–12 months as needed.
- Assess adherence and percentage LDL-C reduction from baseline.

Considersations

Interpret results of this tool within the clinical context, and consider the following during the clinician-patient discussion:

Absolute risk estimate.
Net benefit of therapy.
Socioeconomic status.
Patient preferences and values.
Risk-enhancing factors, including:
- Family history of premature ASCVD.
- Persistently elevated LDL-C ≥160 mg/dL.
- Metabolic syndrome.
- Chronic kidney disease.
- History of preeclampsia or premature menopause (age <40 years).
- Chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, HIV).
- High-risk ethnicity (e.g., South Asian ancestry).
- Persistent triglyceride elevation ≥175 mg/dL.
Supporting studies, when available:
- Apolipoprotein B ≥130 mg/dL.
- hs-CRP ≥2.0 mg/L.
- Ankle-brachial index (ABI) <0.9.
- Lipoprotein(a) ≥50 mg/dL.

Clinical Guidelines

US Preventive Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.
Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology.

Risk of cardiovascular event (coronary or stroke death or non-fatal MI or stroke) in next 10 years (<5%)

No statin recommended because 10-year risk <5%;
Encourage lifestyle modification
Reassess risk factors every 4-6 years
Some patients with other high risk features may still be appropriate for treatment. Refer to published guidelines below.

Considersations

Interpret results of this tool within the clinical context, and consider the following during the clinician-patient discussion:

Absolute risk estimate.
Net benefit of therapy.
Socioeconomic status.
Patient preferences and values.
Risk-enhancing factors, including:
- Family history of premature ASCVD.
- Persistently elevated LDL-C ≥160 mg/dL.
- Metabolic syndrome.
- Chronic kidney disease.
- History of preeclampsia or premature menopause (age <40 years).
- Chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, HIV).
- High-risk ethnicity (e.g., South Asian ancestry).
- Persistent triglyceride elevation ≥175 mg/dL.
Supporting studies, when available:
- Apolipoprotein B ≥130 mg/dL.
- hs-CRP ≥2.0 mg/L.
- Ankle-brachial index (ABI) <0.9.
- Lipoprotein(a) ≥50 mg/dL.

Clinical Guidelines

US Preventive Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.
Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology.

Additional Risk Markers Supporting Upward Revision

Number of the optional markers recorded (family history of premature CVD, hs-CRP, coronary artery calcium, ankle-brachial index) that fall in the range the guideline describes as supporting revising the risk assessment upward.

Citation

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PWF. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(suppl 2):S49-S73.

Literature

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Jun 24;129(25 Suppl 2):S49-73.
https://pubmed.ncbi.nlm.nih.gov/24222018/
Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2889-934.
https://pubmed.ncbi.nlm.nih.gov/24239923/
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10;140(11):e596-e646. doi: 10.1161/CIR.0000000000000678. Epub 2019 Mar 17. Erratum in: Circulation. 2019 Sep 10;140(11):e649-e650.
https://pubmed.ncbi.nlm.nih.gov/30879355/
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Jun 18;139(25):e1082-e1143.
https://pubmed.ncbi.nlm.nih.gov/30586774/
Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC Jr, Sperling LS, Virani SS, Blumenthal RS. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. Circulation. 2019 Jun 18;139(25):e1162-e1177.
https://pubmed.ncbi.nlm.nih.gov/30586766/
US Preventive Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(8):746–753.
https://jamanetwork.com/journals/jama/fullarticle/2795521
Blumenthal RS, Morris PB, Gaudino M, Johnson HM, Anderson TS, Bittner VA, Blankstein R, Brewer LC, Cho L, de Ferranti SD, Gianos E, Gluckman TJ, Gradney KF, Isiadinso I, Lloyd-Jones DM, Marrs JC, Martin SS, McLain KH, Mehta LS, Mora S, Mulugeta WM, Natarajan P, Navar AM, Orringer CE, Polonsky TS, Reynolds HR, Saseen JJ, Shapiro MD, Soffer DE, Tynes SA, Villavaso CD, Virani SS, Wilkins JT. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2026 May 19;87(19):2624-2757.
https://pubmed.ncbi.nlm.nih.gov/41824590/
Khan SS, Matsushita K, Sang Y, Ballew SH, Grams ME, Surapaneni A, Blaha MJ, Carson AP, Chang AR, Ciemins E, Go AS, Gutierrez OM, Hwang SJ, Jassal SK, Kovesdy CP, Lloyd-Jones DM, Shlipak MG, Palaniappan LP, Sperling L, Virani SS, Tuttle K, Neeland IJ, Chow SL, Rangaswami J, Pencina MJ, Ndumele CE, Coresh J; Chronic Kidney Disease Prognosis Consortium and the American Heart Association Cardiovascular-Kidney-Metabolic Science Advisory Group. Development and Validation of the American Heart Association's PREVENT Equations. Circulation. 2024 Feb 6;149(6):430-449. doi: 10.1161/CIRCULATIONAHA.123.067626. Epub 2023 Nov 10. Erratum in: Circulation. 2024 Mar 12;149(11):e956.
https://pubmed.ncbi.nlm.nih.gov/37947085/
Zhou H, Zhang Y, Zhou MM, Choi SK, Reynolds K, Harrison TN, Bellows BK, Moran AE, Colantonio LD, Allen NB, Safford MM, An J. Evaluation and Comparison of the PREVENT and Pooled Cohort Equations for 10-Year Atherosclerotic Cardiovascular Risk Prediction. J Am Heart Assoc. 2025 Feb 18;14(4):e039454.
https://pubmed.ncbi.nlm.nih.gov/39921505/

All questions & possible results

Citation

Literature

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