ASCVD risk calculator (Pooled Cohort Equations)

ASCVD calculator or PREVENT?

The Pooled Cohort Equations were released with the 2013 ACC/AHA risk guideline (Goff 2013). The American Heart Association introduced its newer PREVENT equations in 2023 (published online in November 2023, in print in 2024) (Khan 2024). PREVENT uses more recent data, does not use race, adds kidney function and statin use, starts at age 30 and can also predict heart failure (Khan 2024). In a national sample of US adults, the average 10-year estimate was 8.0% with the Pooled Cohort Equations and 4.3% with PREVENT (Anderson 2024).

The 2018 cholesterol guideline, still widely used for statin decisions, uses the Pooled Cohort Equations (AHA/ACC 2018). So you may be asked for this older number. Our PREVENT heart risk calculator gives the newer estimate, and PREVENT vs ASCVD explains why the two differ.

What it predicts

"Hard ASCVD" in the 2013 equations means a first nonfatal heart attack, death from coronary heart disease, or a fatal or nonfatal stroke, over 10 years, in people free of these at the start (Goff 2013). The inputs are sex, race, age, total and HDL cholesterol, systolic blood pressure, whether it is treated, current smoking and diabetes (Goff 2013).

The equations

There is one equation for each of four groups: White women, African American women, White men and African American men (Goff 2013). Age, cholesterol and blood pressure enter as natural logs, some multiplied by the log of age. Each value is multiplied by its coefficient and the results are added up. The 10-year risk is then (Goff 2013):

risk = 1 − S10^{e(individual sum − group mean)}

From Table A of the guideline (Goff 2013). The full coefficients are in the guideline's Table A; our calculator uses them exactly as printed.

The guideline's worked example

The guideline works through one person: age 55, total cholesterol 213 mg/dL, HDL 50 mg/dL, untreated systolic blood pressure 120 mm Hg, not smoking, no diabetes (Goff 2013). Its printed 10-year risks are 2.1% for White women, 3.0% for African American women, 5.3% for White men and 6.1% for African American men (Goff 2013). For White men it shows the last step: 1 − 0.9144^{e(60.69 − 61.18)} = 5.3% (Goff 2013). Our tests reproduce all four results from the printed sums. Computed without rounding, the White man's result comes out at 5.4%, because the table rounds the logs and the sum to two decimals.

Race and other groups

The equations should be used in non-Hispanic African American and non-Hispanic White adults aged 40 to 79 (Goff 2013). Data for other groups were not enough to build their own equations (Goff 2013). For other groups, the guideline says the equations for White adults may be considered, and that they may overestimate risk, especially for Hispanic and Asian Americans (Goff 2013). The 2018 cholesterol guideline adds that they may underestimate risk in South Asian and overestimate it in East Asian people (AHA/ACC 2018).

What the result is used for

For adults 40 to 75 without diabetes, the 2018 cholesterol guideline calls a 10-year risk of 5% to under 7.5% "borderline" and 7.5% to 19.9% "intermediate" (AHA/ACC 2018). At 7.5% or more, with LDL cholesterol of 70 mg/dL or more, it suggests a clinician and patient discuss starting a moderate-intensity statin (AHA/ACC 2018). At 20% or more, it says a statin should aim to lower LDL cholesterol by 50% or more (AHA/ACC 2018). It also notes that the equations can overestimate or underestimate risk for a single person (AHA/ACC 2018). The number is a starting point for a talk with your clinician, not a decision.

Input limits

The guideline sets the age range at 40 to 79 (Goff 2013). It prints no limits for cholesterol or blood pressure. Our editorial team limits total cholesterol to 130 to 320 mg/dL, HDL to 20 to 100 mg/dL and systolic blood pressure to 90 to 200 mm Hg, so the equations are not run on extreme values; the guideline says they were not developed for people with very high values from conditions such as familial hypercholesterolemia (Goff 2013).

Related checks

The PREVENT heart risk calculator gives the American Heart Association's newer 10 and 30-year estimate. The statin eligibility check walks through the USPSTF criteria, which use this ASCVD estimate, and the LDL calculator works out LDL from a standard cholesterol panel. Asked for a Framingham score instead? The Framingham risk calculator uses the 2008 general CVD equations.