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ASCVD (Atherosclerotic Cardiovascular Disease) 2013 Risk Calculator from AHA/ACC

Determine 10-year risk of hard ASCVD, i.e. myocardial infarction, stroke, or death due to coronary heart disease or stroke.

  • Our ASCVD Risk Algorithm is a step-wise approach for all adult patients – including those with known ASCVD.
  • This calculator is for use only in adult patients without known ASCVD and LDL 70-189 mg/dL (1.81-4.90 mmol/L).
When To Use
  • Apply to asymptomatic adults aged 40–75 years with LDL-C 70–189 mg/dL without known ASCVD when considering primary prevention interventions, particularly statin therapy.
  • Refrain from using in:
    • Adults <40 or >75 years of age (limited data on performance).
    • Patients with known ASCVD.
    • Adults with LDL-C ≥190 mg/dL, including familial hypercholesterolemia (lipid-lowering therapy is indicated regardless of calculated risk).
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Clinical Advice

Interpret results of this tool within the clinical context, and consider the following during the clinician-patient discussion:

  • Absolute risk estimate.
  • Net benefit of therapy.
  • Socioeconomic status.
  • Patient preferences and values.
  • Risk-enhancing factors, including:
    • Family history of premature ASCVD.
    • Persistently elevated LDL-C ≥160 mg/dL.
    • Metabolic syndrome.
    • Chronic kidney disease.
    • History of preeclampsia or premature menopause (age <40 years).
    • Chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, HIV).
    • High-risk ethnicity (e.g., South Asian ancestry).
    • Persistent triglyceride elevation ≥175 mg/dL.
  • Supporting studies, when available:
    • Apolipoprotein B ≥130 mg/dL.
    • hs-CRP ≥2.0 mg/L.
    • Ankle-brachial index (ABI) <0.9.
    • Lipoprotein(a) ≥50 mg/dL.

Management

Treatment thresholds based on this tool are historical, as ACC/AHA dyslipidemia guidelines now recommend PREVENT for primary prevention risk assessment; if this tool is used, the following management thresholds might be considered:

  • 10-year ASCVD risk ≥7.5%: Consider initiating moderate- or high-intensity statin therapy after clinician-patient discussion.
    • If 10-year risk ≥20%: Consider high-intensity statin to reduce LDL-C ≥50%.
    • If 10-year risk 7.5%–19.9%: Consider moderate-intensity statin to reduce LDL-C ≥30%.
  • 10-year ASCVD risk 5% to <7.5%:
    • Evaluate risk-enhancing factors.
    • Consider statin therapy if risk enhancers present.
    • May use coronary artery calcium (CAC) scoring to refine the treatment decision.
  • 10-year ASCVD risk <5%:
    • Emphasize lifestyle modification.
    • Reassess risk factors every 4–6 years.
  • For stage 1 hypertension (130–139/80–89 mm Hg): Categorize as <10% or ≥10% 10-year ASCVD risk for therapeutic decisions, and refer to most recent AHA/ACC guidelines.
  • Follow-up:
    • Reassess lipids 4–12 weeks after statin initiation or dose adjustment.
    • Repeat every 3–12 months as needed.
    • Assess adherence and percentage LDL-C reduction from baseline.