How to use the ASCVD Risk
- Enter age, sex and race group as used by the pooled cohort equations.
- Enter total cholesterol, HDL and systolic blood pressure.
- Indicate diabetes, smoking status and blood pressure treatment.
- Read the 10-year risk percentage and the risk category it falls into.
How the calculation works
The pooled cohort equations combine age, sex, race, total and HDL cholesterol, systolic pressure, treatment status, diabetes and smoking into a log-linear model, and the output is the estimated probability of a first hard ASCVD event within ten years. Conventional bands are low (<5%), borderline (5–7.4%), intermediate (7.5–19.9%) and high (≥20%), with statin therapy generally discussed from the intermediate band upward.
Age dominates the equation, which is why an older person with excellent numbers can still score above 7.5% while a younger person with poor numbers scores low. That is a known limitation, and it is why guidelines add risk-enhancing factors — family history of premature disease, chronic inflammatory conditions, elevated lipoprotein(a) — and coronary artery calcium scoring to refine borderline decisions. The equations are validated for ages 40–79 and were derived in US cohorts, so they may miscalibrate elsewhere.
Pooled cohort equations: risk = 1 − S₁₀^exp(Σβᵢxᵢ − mean)Source: ACC/AHA Pooled Cohort Equations for 10-year ASCVD risk (2013 Risk Assessment Guideline, 2018 cholesterol update).
Worked example
A 58-year-old man, total cholesterol 232, HDL 41, systolic 146 untreated, non-smoker, no diabetes.
- Age and systolic pressure contribute the largest positive terms.
- Low HDL adds further risk; absence of smoking and diabetes reduces it.
- Pooled cohort output ≈ 12.4% ten-year risk.
- That falls in the intermediate band, 7.5–19.9%.
Roughly 12% ten-year risk — intermediate, where guidelines suggest a statin discussion and blood pressure treatment.
Frequently asked questions
Is this a diagnosis?+
No. It is a population-level risk estimate to inform a clinical conversation, never a substitute for one.
Why does age matter so much?+
Age is the strongest single predictor of cardiovascular events, so it dominates the model by design.
What if my risk is borderline?+
Guidelines suggest weighing risk-enhancing factors or a coronary calcium score to decide.
Does it apply outside the US?+
It was derived from US cohorts. Other regions use locally calibrated tools such as SCORE2 or QRISK.
Last reviewed August 31, 2026. We review this page whenever the underlying formula, tax year, published rate or standard changes.