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ASCVD Risk Calculator: 10-Year Pooled Cohort Equations

Enter your age, sex, cholesterol, blood pressure, smoking and diabetes status to estimate the ten-year risk of a first heart attack or stroke with the Pooled Cohort Equations from the 2013 ACC/AHA guideline. The result shows where you sit against the four risk categories that accompanied those equations and what each one meant for a statin conversation. The 2026 ACC/AHA dyslipidemia guideline has since replaced this equation with PREVENT and set lower cut-offs, so ask your clinician for a PREVENT figure as well.

  • Calculator
  • About 4 min
  • Goff 2014 Pooled Cohort Equations
  • Runs in your browser, nothing is sent
  • Medical review: Medical review pending
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What this calculator works out

ASCVD stands for atherosclerotic cardiovascular disease: heart attack, death from coronary disease, and stroke. The Pooled Cohort Equations estimate the chance of a first such event over the next ten years from nine routine facts, and US cholesterol guidelines used that estimate to decide when a statin discussion was warranted until the 2026 guideline moved to the newer PREVENT equations.

  1. 1

    Ten-year risk percent

    The probability, as a percentage, of a first hard ASCVD event (nonfatal heart attack, coronary death, fatal or nonfatal stroke) in the next ten years for someone with your profile and no existing cardiovascular disease. A 7.5 percent result means that about 7 or 8 of 100 people with the same numbers would have an event in a decade.

  2. 2

    Guideline risk category

    The 2018 ACC/AHA cholesterol guideline, which the 2026 guideline superseded, sorted the percentage into low (under 5), borderline (5 to under 7.5), intermediate (7.5 to under 20) and high (20 and above). Those are the thresholds that accompanied this equation, and each band on the result page states what the 2018 guideline said about statins, risk-enhancing factors and coronary calcium scoring at that level. The 2026 guideline reads PREVENT risk against lower cut-offs of 3, 5 and 10 percent.

  3. 3

    The equation itself

    The sex- and race-specific coefficients, the cohort mean and the baseline survival are shown in the method note, with the guideline's own worked example, so you can see that the number is the published model and not a proprietary variant of it.

How this compares with a typical online quiz

FeatureTypical free quizRegenerated.com
Equation named and coefficients shownSometimesGoff 2014, Appendix 7, Table A
Validated age range enforcedRarelyYes, 40 to 79; outside it the calculator stops
Guideline thresholds citedSometimes2018 ACC/AHA cholesterol guideline bands
Known overestimation statedNoYes, with the MESA calibration study
Newer PREVENT model explainedRarelyYes, in the section below
mg/dL and mmol/L handledSometimesYes, conversion in every field
Answers sent to a serverOftenNever; scored in your browser, counts-only events

What the 2018 guideline did with the number

The 2018 ACC/AHA cholesterol guideline (Grundy and colleagues, 2019), the thresholds that accompanied this equation and that the 2026 guideline has since superseded, used the ten-year risk as the entry point for a clinician-patient risk discussion in adults aged 40 to 75 with LDL cholesterol between 70 and 189 mg/dL and no diabetes or existing cardiovascular disease. At 20 percent and above, a high-intensity statin to lower LDL by at least 50 percent is the guideline's recommendation. Between 7.5 and 20 percent, a moderate-intensity statin is reasonable if the discussion favors it, and risk-enhancing factors push toward treatment. Between 5 and 7.5 percent, a statin may be considered when risk enhancers are present. Under 5 percent, the emphasis is on lifestyle.

Two groups bypass the calculator entirely under those 2018 rules: anyone with LDL cholesterol of 190 mg/dL or more, and adults aged 40 to 75 with diabetes, for whom the guideline advises a statin regardless of the risk score. Risk-enhancing factors the guideline lists include a family history of premature ASCVD (a male relative before 55 or a female relative before 65), persistently elevated LDL of 160 mg/dL or more, metabolic syndrome, chronic kidney disease, chronic inflammatory conditions such as psoriasis, rheumatoid arthritis or HIV, premature menopause or a history of preeclampsia, South Asian ancestry, persistent triglycerides of 175 mg/dL or more, and, where measured, hs-CRP of 2.0 mg/L or more, lipoprotein(a) of 50 mg/dL or more, apolipoprotein B of 130 mg/dL or more, or an ankle-brachial index under 0.9.

Coronary artery calcium: the tie-breaker

When the risk falls in the intermediate band, or in the borderline band with risk enhancers, and the decision is still uncertain, the guideline supports a coronary artery calcium (CAC) scan: a low-dose CT without contrast that scores calcified plaque in the coronary arteries. A score of zero in a non-smoker without diabetes or a strong family history lets a clinician reasonably hold off a statin and repeat the scan in five to ten years. A score of 1 to 99 favors a statin, particularly after age 55. A score of 100 or more, or at the 75th percentile or above for age and sex, indicates a statin at any risk level.

The scan often costs around 100 to 200 dollars out of pocket in the United States, though it varies by center, and involves a small radiation dose. It measures what has already happened in the arteries rather than predicting it, which is why it reclassifies so many people whose equation result sits near a threshold.

PREVENT and the 2026 guideline: what this page computes, and what your clinician will use

In November 2023 the American Heart Association published the PREVENT equations (Khan and colleagues, 2024), derived from more than six million adults in contemporary US cohorts. PREVENT covers ages 30 to 79, drops race as an input, adds kidney function (eGFR) and body mass index, and can take HbA1c, urine albumin and a social deprivation index as optional inputs. It predicts total cardiovascular disease, including heart failure, over ten and thirty years, and it produces lower risk estimates than the Pooled Cohort Equations for most people, because the older equations were built on cohorts from the 1960s to 1990s and overestimate risk in today's population.

The 2026 ACC/AHA multisociety dyslipidemia guideline (Blumenthal and colleagues, published online March 13, 2026) replaced the Pooled Cohort Equations with PREVENT-ASCVD for adults aged 30 to 79, and replaced the 2018 categories with lower cut-offs: low under 3 percent, borderline 3 to under 5, intermediate 5 to under 10, and high 10 percent and above. This page still computes the 2013 equations for two reasons: they are the published model implemented here, and they are the number almost every reader was given before 2026, so they are the figure in older letters, apps and clinic notes. Read the result as exactly that, a 2013 estimate against the thresholds of its own era. A clinician using PREVENT will usually quote a lower percentage read against lower lines, which is not a contradiction. The pair of numbers worth asking for by name at your next appointment: what is my ten-year PREVENT-ASCVD risk, and which category does it fall into.

Methodology and sources

The calculator implements the race- and sex-specific Pooled Cohort Equations published in the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk (Goff and colleagues, 2014), Appendix 7, Table A. The equations were derived from five NHLBI cohorts (Framingham original and offspring, ARIC, CARDIA and CHS) in non-Hispanic White and African American adults aged 40 to 79 without prior cardiovascular disease, and they predict the ten-year risk of a first hard ASCVD event. The guideline specifies that people of other races use the White coefficients, which is why the first race option here is labeled White or other. The equations are valid for ages 40 to 79 and the calculator refuses other ages; the ACC/AHA risk estimator accepts total cholesterol 130 to 320 mg/dL, HDL 20 to 100 mg/dL and systolic pressure 90 to 200 mmHg, and values outside those ranges are extrapolations.

For each group the natural logarithms of age, total cholesterol, HDL cholesterol and systolic blood pressure (with separate coefficients for treated and untreated pressure), a smoking flag, a diabetes flag and the listed interaction terms are multiplied by the published coefficients and summed. The sum minus the cohort mean is exponentiated, and ten-year risk equals 1 minus the group's baseline survival raised to that power. Worked example from the guideline: a 55-year-old White man with total cholesterol 213 mg/dL, HDL 50 mg/dL, untreated systolic pressure 120 mmHg, non-smoker, no diabetes, scores a sum of about 60.70 (the guideline's table prints 60.69) against a mean of 61.18 and a baseline survival of 0.9144, giving a ten-year risk of about 5.4 percent (the guideline's table prints 5.3 from unrounded coefficients). The same profile gives about 2.1 percent for a White woman, 6.1 for a Black man and 3.0 for a Black woman.

The bands use the categories of the 2018 ACC/AHA cholesterol guideline (Grundy and colleagues, 2019), the thresholds that accompanied this equation and that the 2026 ACC/AHA dyslipidemia guideline superseded: low under 5 percent, borderline 5 to under 7.5, intermediate 7.5 to under 20, high 20 and above. The 2026 guideline reads PREVENT risk against 3, 5 and 10 percent instead, so a clinician working from it will quote a different number against different lines. Two limits matter when reading the result. First, in the Multi-Ethnic Study of Atherosclerosis the equations overestimated observed events by 86 percent in men and 67 percent in women in a cohort aged 50 to 74 without diabetes (DeFilippis and colleagues, 2015), so the true risk for a modern, lower-smoking population is often somewhat lower than the number shown. Second, the equations do not see LDL cholesterol, lipoprotein(a), family history, kidney function or inflammation, which is why the guideline added risk enhancers and calcium scoring to the decision rather than relying on the percentage alone.

Medical review: Medical review pending. Last updated .

References

  1. Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49-S73. https://doi.org/10.1161/01.cir.0000437741.48606.98
  2. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Circulation. 2019;139(25):e1082-e1143. https://doi.org/10.1161/CIR.0000000000000625
  3. Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia. J Am Coll Cardiol. Published online March 13, 2026. https://doi.org/10.1016/j.jacc.2025.11.016
  4. DeFilippis AP, Young R, Carrubba CJ, et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015;162(4):266-275. https://doi.org/10.7326/M14-1281
  5. Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association's PREVENT equations. Circulation. 2024;149(6):430-449. https://doi.org/10.1161/CIRCULATIONAHA.123.067626

ASCVD Risk Calculator: 10-Year Pooled Cohort Equations FAQ

A first hard atherosclerotic event: nonfatal heart attack, death from coronary heart disease, or a fatal or nonfatal stroke. The equations do not include angina, revascularization procedures, heart failure or peripheral artery disease, which is one reason the newer PREVENT model, which predicts total cardiovascular disease, gives different numbers.

The Pooled Cohort Equations were derived and validated only in adults aged 40 to 79, and the 2018 and 2019 guidelines, which the 2026 guideline superseded, did not endorse using them outside that range. For adults aged 20 to 39 those guidelines suggested estimating lifetime risk and focusing on risk factors; for people 80 and over, the decision rests on overall health and preferences rather than a score. The PREVENT equations, which the 2026 guideline adopted, start at age 30.

No. The equations estimate the risk of a first event in people without existing cardiovascular disease. Anyone with a prior heart attack, stroke, stent, bypass, peripheral artery disease or symptomatic carotid disease is already in the secondary prevention group, where the guideline advises statin treatment without a risk calculation.

Total and HDL cholesterol in mg/dL, as US laboratories report them. If your report is in mmol/L, multiply by 38.67 (5.5 mmol/L is 213 mg/dL). Systolic blood pressure in mmHg, ideally the average of several seated readings rather than a single office number. Answer yes to blood pressure treatment only if you take a medicine for it.

Often, yes. In the Multi-Ethnic Study of Atherosclerosis, which followed a modern cohort for about ten years, the 2013 equations overestimated events by 86 percent in men and 67 percent in women in a cohort aged 50 to 74 without diabetes (DeFilippis and colleagues, 2015). That overestimation is one of the reasons the 2026 ACC/AHA dyslipidemia guideline moved to the PREVENT equations, which were fitted on contemporary data and are read against lower cut-offs of 3, 5 and 10 percent. Treat the percentage here as a conversation starter, not a verdict, and ask your clinician for your PREVENT estimate.

Yes. Your answers and the numbers you enter are scored in your browser and are never sent to us. They stay in this browser tab so you can return to your result, and closing the tab clears them. The only thing the page sends us is a counts-only event: which test was started or completed, the result band and the headline number, with no answers, no entered values and no account. There is nothing to sign up for.

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Important: This calculator is educational arithmetic on numbers you enter. It is a population-derived estimate of ten-year risk, not a prediction for you as an individual, not a diagnosis of heart disease and not a recommendation for or against a statin or any other treatment. The equations are known to overestimate risk in some groups and do not include LDL, lipoprotein(a), family history or kidney function. Only a clinician who knows your history can interpret the result. If your symptoms are severe or sudden, seek urgent medical care.