Heart & circulation

ASCVD risk calculator (2013 Pooled Cohort Equations)

Estimate your 10-year risk of a first heart attack or stroke with the 2013 ACC/AHA Pooled Cohort Equations, the equations behind the ACC ASCVD Risk Estimator. Enter your age, cholesterol and blood pressure and answer a few yes-or-no questions; the result is placed in the low, borderline, intermediate or high risk category used by US guidelines. It is for adults aged 40 to 79 who have never had a heart attack or stroke. The newer AHA PREVENT equations are available too, in the PREVENT calculator on this site.

AgeyearsThe equations were developed for adults aged 40 to 79. Outside that range they give no estimate.SexThere are separate equations for women and men.RaceThe 2013 equations were built separately for non-Hispanic White and African American adults. For everyone else the guideline suggests the White equations, which may overestimate risk, especially for Hispanic and Asian Americans. The PREVENT calculator has no race input.Total cholesterolmg/dLFrom a recent lipid panel. The calculator accepts 130 to 320 mg/dL, the same range as the ACC estimator.HDL cholesterolmg/dLThe HDL ("good") cholesterol from the same panel. Accepted range 20 to 100 mg/dL.Systolic blood pressuremmHgThe top number of your blood pressure reading. Accepted range 90 to 200 mmHg.Taking blood pressure medicineAnswer yes if you currently take any medicine to lower your blood pressure.DiabetesAnswer yes if a clinician has diagnosed diabetes.Current smokerAnswer yes if you smoke now.

Enter your values above to see your result and what it means.

What is a 10-year ASCVD risk score?

ASCVD stands for atherosclerotic cardiovascular disease. The 10-year ASCVD risk is the estimated chance of a first heart attack, death from coronary heart disease, or fatal or nonfatal stroke over the next 10 years, in someone who has never had one. The Pooled Cohort Equations behind it were published with the 2013 ACC/AHA guideline on cardiovascular risk assessment. They were derived from several long-running community cohort studies funded by the US National Heart, Lung, and Blood Institute, representative of White and African American adults, and they remain the risk equations named in the 2019 ACC/AHA primary prevention guideline. The score estimates population risk for people without established cardiovascular disease; it is a conversation starter with a clinician and does not decide treatment.

ASCVD risk categories: what is a good ASCVD score?

A 10-year risk below 5% counts as low. The 2018 cholesterol guideline and the 2019 primary prevention guideline add borderline (5% to under 7.5%), intermediate (7.5% to under 20%) and high (20% or more). The categories were written for adults aged 40 to 75 without diabetes and with LDL cholesterol between 70 and 189 mg/dL; adults with diabetes, and anyone with LDL of 190 mg/dL or higher, follow separate pathways. This calculator assigns the category from the result rounded to one decimal place.

10-year ASCVD risk categories (2018 and 2019 ACC/AHA guidelines)
Category	10-year ASCVD risk	What the guidelines focus on
Low	below 5%	Healthy lifestyle to keep risk factors down
Borderline	5% to 7.4%	Risk-enhancing factors can refine the estimate
Intermediate	7.5% to 19.9%	Risk discussion with a clinician; risk-enhancing factors and sometimes a coronary calcium scan
High	20% or more	Risk discussion with a clinician

How the Pooled Cohort Equations calculate risk

There are four equations: White women, African American women, White men and African American men. Each takes the natural logarithms of age, total cholesterol, HDL cholesterol and systolic blood pressure, multiplies them by published coefficients (with a separate coefficient for treated and untreated blood pressure), adds terms for smoking and diabetes, and converts the sum into a 10-year probability using the baseline survival of each group. The guideline gives a worked example: age 55, total cholesterol 213 mg/dL, HDL 50 mg/dL, untreated systolic pressure 120 mmHg, nonsmoker, no diabetes. This calculator reproduces three of the four published results. For White men the guideline prints 5.3% because its table truncates the intermediate sum to two decimals (60.69 instead of 60.6995); the exact arithmetic gives 5.38%, shown as 5.4%, the same figure the ACC online estimator returns.

Guideline worked example (age 55, TC 213, HDL 50, untreated SBP 120, nonsmoker, no diabetes)
Equation	Published 10-year risk	This calculator
White women	2.1%	2.1%
African American women	3.0%	3.0%
White men	5.3%	5.4%
African American men	6.1%	6.1%

Pooled Cohort Equations vs PREVENT, and other limits

In 2023 the American Heart Association published the PREVENT equations, which start at age 30, contain no race term, add kidney function and statin use, and also predict heart failure. In the data used to validate PREVENT, the Pooled Cohort Equations overestimated ASCVD risk by about 50%, so expect PREVENT to give a lower figure for the same person (try the PREVENT calculator at symptomatik.com/calculators/prevent/). The Pooled Cohort Equations also need a race input: people who are neither non-Hispanic White nor African American are calculated with the White equations, which may overestimate their risk. They do not apply to anyone who has already had a heart attack or stroke, and they give no estimate outside ages 40 to 79 or outside the input ranges above.

Frequently asked questions

What is ASCVD?

ASCVD stands for atherosclerotic cardiovascular disease. In this calculator it means a first heart attack, death from coronary heart disease, or a fatal or nonfatal stroke.

What is a good 10-year ASCVD risk score?

Below 5% is classed as low risk by the 2018 and 2019 ACC/AHA guidelines. Borderline is 5% to 7.4%, intermediate 7.5% to 19.9%, and high 20% or more. Lower is better at any age.

At what ASCVD risk is a statin discussed?

The guidelines use 7.5% or higher as the range where a clinician and patient talk through statin therapy, and borderline risk with risk-enhancing factors can lead to the same conversation. The decision also depends on LDL cholesterol, other conditions and your preferences, so a calculator cannot make it. Do not start or stop a medicine on the basis of this result.

Why does the ASCVD calculator ask about race?

The 2013 equations were built separately for non-Hispanic White and African American adults from US cohort studies. For other groups the guideline suggests the White equations and warns they may overestimate risk, especially for Hispanic and Asian Americans. The newer PREVENT equations removed race altogether.

Should I use the ASCVD risk calculator or the PREVENT calculator?

The Pooled Cohort Equations remain in the 2019 ACC/AHA guideline and in the ACC online estimator, so many clinicians still quote them. PREVENT is the newer AHA equation and was better calibrated in modern data. Running both and bringing the two numbers to your clinician is a reasonable way to start the conversation.