ASCVD Risk Calculator (2013 Pooled Cohort Equations)
Estimate 10-year risk of heart attack or stroke with the 2013 ACC/AHA Pooled Cohort Equations, including the African American equations, cholesterol in mg/dL or mmol/L, risk with optimal risk factors, lifetime risk for ages 20–59 and what-if scenarios.
How it works
10-year risk = 1 − S₀^exp(Σ βᵢxᵢ − group mean) · xᵢ = ln(age), ln(total cholesterol), ln(HDL), ln(systolic BP, treated or untreated), smoker, diabetes and some products with ln(age) · S₀ and mean: White men 0.9144 / 61.18, African American men 0.8954 / 19.54, White women 0.9665 / −29.18, African American women 0.9533 / 86.61 · mmol/L × 38.67 = mg/dL
The Pooled Cohort Equations, published with the 2013 ACC/AHA cardiovascular risk guideline, estimate the chance that a person aged 40–79 with no heart disease will have a first “hard” ASCVD event (a heart attack, death from coronary heart disease, or a fatal or non-fatal stroke) in the next 10 years. There are four sets of coefficients: White and African American men and women. Each takes the natural log of age, total cholesterol, HDL cholesterol and systolic blood pressure (with a different weight when blood pressure is treated), adds terms for smoking and diabetes, subtracts the group mean and puts the result through the baseline survival. The calculator follows the published coefficients exactly and accepts only the validated input ranges (total cholesterol 130–320 mg/dL, HDL 20–100 mg/dL, systolic pressure 90–200 mmHg), as the ACC estimator does. It also shows the risk the same person would have with optimal risk factors (total cholesterol 170, HDL 50, untreated systolic 110, no smoking or diabetes), a what-if table, risk by age, and for ages 20–59 the lifetime risk groups the ACC tool uses. Guidelines now also offer the AHA PREVENT equations, which drop race and add kidney function; their numbers are usually lower, so the two scores should not be compared against the same thresholds.
Worked example
The guideline’s own worked example is a 55-year-old with total cholesterol 213 mg/dL, HDL 50 mg/dL, untreated systolic blood pressure 120 mmHg, no smoking and no diabetes. For a White man the individual sum is 60.70; subtracting the mean of 61.18 gives −0.48, and exp(−0.48) ≈ 0.62, so risk = 1 − 0.9144^0.62 ≈ 5.4% (borderline; the guideline’s table shows 5.3% because it rounds each term before adding). The same profile gives 6.1% for an African American man, 2.1% for a White woman and 3.0% for an African American woman. With optimal risk factors the White man’s risk would be about 3.6%.
Sources: Goff et al., 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk (Circulation 2014) · Grundy et al., 2018 AHA/ACC Guideline on the Management of Blood Cholesterol · ACC ASCVD Risk Estimator · Lloyd-Jones et al., Prediction of lifetime risk for cardiovascular disease (Circulation 2006)
Frequently asked questions
What ASCVD risk triggers a statin discussion?
Under the 2018 AHA/ACC cholesterol guideline, 7.5% or more (intermediate) usually leads to a talk about a moderate-intensity statin, and 20% or more (high) about a statin strong enough to cut LDL by half. In the 5–7.4% borderline range, risk enhancers such as family history, chronic kidney disease or a high Lp(a) can tip the decision. A coronary artery calcium score can help when the choice is unclear.
Why is the age range limited to 40–79?
The 10-year equations were developed and validated in that age range, so they are unreliable outside it. For ages 20–59 the calculator shows lifetime risk instead, using the risk-factor groups from the ACC estimator.
Does this include the African American equations?
Yes. Choose African American to use that coefficient set. For people of other backgrounds, the guideline recommends the White equations, with the caveat that they may overestimate risk in some groups, such as East Asian adults, and underestimate it in others, such as South Asian adults.
Can I enter cholesterol in mmol/L?
Yes. Pick mmol/L next to the cholesterol fields. The calculator multiplies by 38.67 to get mg/dL, which is what the equations use.
What does “risk with optimal risk factors” mean?
It is the risk for someone of your age, sex and race with total cholesterol 170 mg/dL, HDL 50 mg/dL, untreated systolic pressure 110 mmHg, no smoking and no diabetes. The gap between your risk and this number is the part that risk-factor changes could address.
How is this different from the PREVENT calculator?
PREVENT (AHA, 2023) estimates risk for ages 30–79 without race, adds kidney function and can include heart failure. For the same person it usually gives a lower number, so its results are read against lower thresholds. Your clinician may use either.
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Educational clinical estimate only — not a diagnosis, medical advice, or treatment. Scores are screening aids that must be interpreted by a qualified clinician alongside the full clinical picture. Never make care decisions from this tool alone.