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10-year risk of atherosclerotic cardiovascular disease (first nonfatal myocardial infarction, coronary heart disease death, or fatal/nonfatal stroke) using the 2013 ACC/AHA Pooled Cohort Equations, the basis of the 2018 ACC/AHA cholesterol guideline statin decisions.
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
ASCVD risk categories (2018 ACC/AHA): <5% low, 5–7.4% borderline, 7.5–19.9% intermediate, ≥20% high. In adults 40–75 years without clinical ASCVD, risk estimates guide statin therapy. The equations are validated for ages 40–79, total cholesterol 130–320 mg/dL, HDL 20–100 mg/dL, and SBP 90–200 mmHg. White/other equations are applied to all non-Black races.
Specialty
CardiologyCategory
CardiologyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-15
Formula
Keywords
Normal Range
0–100% 10-year risk
Estimates 10-year risk of first atherosclerotic cardiovascular disease event (nonfatal MI, coronary heart disease death, or fatal/nonfatal stroke) using the ACC/AHA Pooled Cohort Equations.
The 2013 ACC/AHA Pooled Cohort Equations combine age, total cholesterol, HDL cholesterol, systolic blood pressure (with treatment status), smoking, and diabetes in sex- and race-specific Cox models. A linear predictor is computed from the log-transformed risk factors and converted to a 10-year ASCVD risk percentage for patients aged 40-79 years.
Age in years (40-79), entered as a natural logarithm in the equations.
Biological sex, which selects the male- or female-specific equation.
African American or White/other, which selects the race-specific equation coefficients.
Total cholesterol in mg/dL, entered as a natural logarithm.
HDL cholesterol in mg/dL, entered as a natural logarithm.
Systolic blood pressure in mmHg, entered as a natural logarithm with treatment-specific coefficients.
Whether hypertension is untreated or treated, which selects the corresponding blood-pressure coefficients.
Current smoking; Yes contributes with age-interaction terms.
Diabetes; Yes contributes a coefficient to the linear predictor.
<5%: low; 5–7.4%: borderline; 7.5–19.9%: intermediate; ≥20%: high risk. In adults 40–75 years, borderline/intermediate risk prompts a clinician–patient risk discussion, often supported by risk-enhancing factors or coronary artery calcium scoring.
The Pooled Cohort Equations are the foundation of modern primary prevention statin guidelines, quantifying ASCVD risk to target preventive therapy where it provides the greatest benefit.
A 55-year-old white man, nonsmoker, without diabetes or hypertension treatment, has total cholesterol 213 mg/dL, HDL 50 mg/dL, and systolic blood pressure 120 mmHg.
Inputs:
Expected Result: 10-year ASCVD risk ≈ 5.4% — BORDERLINE risk. A risk discussion is warranted; risk-enhancing factors may influence statin initiation.
It estimates 10-year risk of a first atherosclerotic cardiovascular disease event in adults aged 40-79 years without established clinical ASCVD, combining age, total and HDL cholesterol, systolic blood pressure with treatment status, smoking, and diabetes. Patients with existing ASCVD should be managed through secondary prevention pathways instead. The equations are validated for total cholesterol 130-320 mg/dL, HDL 20-100 mg/dL, and systolic pressure 90-200 mmHg.
The 2018 ACC/AHA categories are less than 5% (low), 5-7.4% (borderline), 7.5-19.9% (intermediate), and 20% or higher (high). In adults 40-75 years, borderline or intermediate risk prompts a clinician-patient risk discussion, often supported by risk-enhancing factors or coronary artery calcium scoring. The categories guide preventive treatment discussions rather than dictating a specific therapy.
The equations were derived from US cohorts in the 1990s-2000s, so contemporary populations may have lower event rates. Risk can be overestimated or underestimated in groups such as Hispanic/Latino, South Asian, and older adults. The estimate addresses only 10-year risk, so lifetime risk is a separate consideration, particularly for younger adults. Clinical judgment remains essential for unusual phenotypes.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. ASCVD risk estimates are population-based and must be interpreted in the context of the individual patient.