How to calculate your 10-year ASCVD risk (Pooled Cohort Equations)

ASCVD stands for atherosclerotic cardiovascular disease: heart attacks and strokes caused by plaque building up in arteries. When a doctor talks about "your 10-year risk" before suggesting a statin, this is usually the number they mean. The ASCVD Risk Calculator implements the ACC/AHA Pooled Cohort Equations, published with the 2013 cardiovascular risk guideline, and runs entirely in your browser. Nothing you type leaves the page.

How it works

1. Select sex and race group. The equations were derived separately for White/other and African American men and women.
2. Enter age (40–79), total cholesterol, HDL, and systolic blood pressure, and mark whether you take BP medication, have diabetes, or smoke.
3. Read the result. The 10-year risk percentage and its ACC/AHA category update as you type.

What the risk bands mean

The 2018 AHA/ACC cholesterol guideline splits the result into four bands. Below 5% is low risk, and the advice is mostly about lifestyle. From 5 to 7.4% is borderline: things the equations don't capture, like family history or a high Lp(a), can tip the decision toward a statin. From 7.5 to 19.9% is intermediate, where a moderate-intensity statin is usually on the table and a coronary calcium score can settle a close call. At 20% or above, guidelines generally recommend a high-intensity statin.

The math behind it

The Pooled Cohort Equations are sex- and race-specific Cox proportional hazards models. Each input is log-transformed, multiplied by a published coefficient, and summed; the 10-year risk is 1 − S₀^exp(sum − mean), where S₀ is the group's baseline survival. Our implementation uses the coefficient set from the ONC Million Hearts reference implementation and is unit-tested against the worked example in the 2013 guideline appendix. One quirk worth knowing: the appendix prints 5.3% for its example patient because it rounds an intermediate sum, while full-precision implementations (including the official ACC estimator and this one) get 5.4%.

Limitations to know

The equations apply to adults 40–79 without known cardiovascular disease, and studies have found they overestimate risk in some modern, higher-income populations. They also predate the AHA's 2023 PREVENT equations, which add kidney function and BMI, remove race, and predict heart failure. Treat the output as a conversation starter, and bring the number to your clinician rather than acting on it alone.

The ASCVD Risk Calculator is free and runs locally in your browser. See every cardiology score in the Health → Score hub, or compare calculators in Framingham vs ASCVD vs PREVENT.