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ASCVD Risk Estimator Plus
  • Estimate Risk
  • Therapy Impact
    • Potential risk reduction impact of different therapies can only be calculated for patients 40-79 years of age at an initial visit.
  • Advice
    • Advice section is accessible when required characteristics for patients 40-79 years of age are entered.
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Intermediate
This calculator only provides 10-year risk estimates for individuals 40-79 years of age. Click here to view brief suggestions for younger patients.
Current 10-Year
ASCVD Risk**
~%
Previous 10-Year
ASCVD Risk
Lifetime ASCVD Risk:   Lifetime Risk Calculator only provides lifetime risk estimates for individuals 20 to 59 years of age.
Optimal ASCVD Risk:   Optimal ASCVD Risk Calculator only provides optimal risk estimates for individuals 40 to 79 years of age.
Important Notice: All ACC-related web platforms will be unavailable from Friday, May 10 until Tuesday, May 21 as part of system-wide upgrade to ACC’s digital infrastructure. Please plan accordingly. Mobile versions of the clinical apps remain available on the GooglePlay and Apple Store.
Welcome to the ASCVD Risk Estimator Plus

Terms of Service

Click the Terms tab at the bottom of the app before using the ASCVD Risk Estimator Plus (“the Product”) to read the full Terms of Service and License Agreement (the “Agreement”) which governs the use of the Product. The Agreement includes, among other detailed terms and conditions, certain disclaimers of warranties by the American College of Cardiology Foundation (“ACCF”) and requires the user to agree to release ACCF from any and all liability arising in connection with your use of the Product. By using the Product, you accept and agree to be bound by all of the terms and conditions set forth in the Agreement, including such disclaimers and releases. If you do not accept the terms and conditions of the Agreement, you may not proceed to use the Product. The Agreement is subject to change from time to time, and your continued use of the Product constitutes your acceptance of and agreement to be bound by any revised terms of the Agreement.

For Optimal Use:
  • Estimate patient’s 10-year ASCVD risk at an initial visit to establish a reference point.
  • Forecast the potential impact of different interventions on patient risk.
  • Reassess ASCVD risk at follow-up visits. Follow up risk incorporates change in risk factor levels over time and requires both initial and follow up values.
  • Use the information above to help with clinician-patient discussions on risk and risk-lowering interventions.

See the “About” "About the App" screen in this app for a definition of terms and additional instructions.

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App should be used for primary prevention patients (those without ASCVD) only.
Age must be between 20-79
Note: These estimates mayunderestimate the 10-year and lifetime risk for persons from some race/ethnic groups, especially American Indians, some Asian Americans (e.g., of south Asian ancestry), and some Hispanics (e.g., Puerto Ricans), and mayoverestimate the risk for others, including some Asian Americans (e.g., of east Asian ancestry) and some Hispanics (e.g., Mexican Americans). Because the primary use of these risk estimates is to facilitate the very important discussion regarding risk reduction through lifestyle change, the imprecision introduced is small enough to justify proceeding with lifestyle change counseling informed by these results.
Value must be between 90-200
Value must be between 60-130
Value must be between 130 - 320
Value must be between 3.367 - 8.288
Value must be between 20 - 100
Value must be between 0.518 - 2.59
Value must be between 30-300
Value must be between 0.777-7.770

Values at Previous Visit

Age is Missing
Age must be between 40-79
Total Cholesterol is Missing
Value must be between 130 - 320
Value must be between 3.367 - 8.288
Value must be between 20 - 100
Value must be between 0.518 - 2.59
LDL Cholesterol at Initial Visit is Missing
Value must be between 30-300
Value must be between 0.777-7.770
Systolic Blood Pressure is Missing
Value must be between 90-200
Treatment Hypertension is Missing
Determine Therapy Impact  
Potential risk reduction impact of different therapies can only be calculated for patients 40-79 years of age at an initial visit.
View Advice  
Advice section is accessible when required characteristics for patients 40-79 years of age are entered.
Determine Therapy Impact  
Potential risk reduction impact of different therapies can only be calculated for patients 40-79 years of age at an initial visit.
View Advice  
Advice section is accessible when required characteristics for patients 40-79 years of age are entered.

For more information about the inputs and calculations used in this app, see “Terms and Concepts” in the Resources tab below.
**10-year risk for ASCVD is categorized as:
Low-risk (<5%)
Borderline risk (5% to 7.4%)
Intermediate risk (7.5% to 19.9%)
High risk (≥20%)
 Indicates a field required to calculate current 10-year ASCVD risk for patients age 40-79 or Lifetime risk for patients age 20-59. Risk will automatically calculate once these fields are populated.
 Indicates additional questions required to determine individualized patient advice for patients age 40-79. Answering these questions in addition to the indicated risk fields will activate the Therapy Impact and Advice tabs.

Project Risk Reduction by Therapy

View Advice Summary for this Patient

Continue usual care at MD’s discretion.

  • LDL-C:
  • Diabetes:
  • Smoking:
  • Aspirin:

Lifestyle:The most important way to prevent ASCVD is to promote a healthy lifestyle throughout life. Medications to reduce ASCVD risk should only be considered part of a shared decision-making process for optimal treatment when a patient's risk is sufficiently high. Decisions around the therapies listed above are assumed to be made in the context of ACC/AHA guideline-recommended lifestyle interventions.

Projected 10-Year ASCVD Risk

T1 15.3 % Stop Smoking, Add Statin Treatments

  Add New Treatment Scenario


*Guidelines do not recommend statin therapy for patients with 10-year risk < 5%
*Guidelines do not typically recommend aspirin therapy for patients with 10-year risk < 10%
*ACC/AHA Guidelines do not specify antihypertensive drug therapy for SBP<120 mmHg (<130 mmHg w/diabetes)
Projected 10-Year ASCVD Risk

T2 15.3 % Stop Smoking, Add Statin Treatments

  Project a Different Therapy Combination


*Guidelines do not recommend statin therapy for patients with 10-year risk < 5%
*Guidelines do not typically recommend aspirin therapy for patients with 10-year risk < 10%
*ACC/AHA Guidelines do not specify antihypertensive drug therapy for SBP<120 mmHg (<130 mmHg w/diabetes)
Projected 10-Year ASCVD Risk

T3 15.3 % Stop Smoking, Add Statin Treatments

  Project a Different Therapy Combination


*Guidelines do not recommend statin therapy for patients with 10-year risk < 5%
*Guidelines do not typically recommend aspirin therapy for patients with 10-year risk < 10%
*ACC/AHA Guidelines do not specify antihypertensive drug therapy for SBP<120 mmHg (<130 mmHg w/diabetes)
Therapy(s) Projected ASCVD Risk for this patient if Therapy Initiated
Statin*
BP drug(s)**
Stop smoking†
Aspirinǂ
Statin + Aspirin
BP drug(s) + Aspirin
Statin + BP drug(s)
Statin + Stop smoking
Stop smoking + Aspirin
BP drug(s) + Stop smoking
Statin + BP drug(s) + Aspirin
BP drug(s) + Stop smoking + Aspirin
Statin + BP drug(s) + Stop smoking
Statin + Stop smoking + Aspirin
Statin + BP drug(s) + Stop smoking + Aspirin
*Start moderate intensity statin, or intensify statin from a moderate to a high intensity dose.
**Start blood-pressure lowering medication if not currently taking, or add BP-lowering med (s) to patient’s existing regime.
†Stop smoking for two years
ǂStart or continue taking aspirin.
¶ NA = Not Applicable. Risk is not shown for therapy(s) that are not recommended. Guidelines do not recommend statin therapy for patients with 10-year ASCVD risk <5%. Guidelines do not typically recommend aspirin therapy for patients with 10-year risk <10%.
View All Risk Reduction Scenarios
View All Risk Reduction Scenarios
  Estimate Risk
View Advice  
Advice section is accessible when required characteristics for patients 40-79 years of age are entered.
  Estimate Risk
View Advice  
Advice section is accessible when required characteristics for patients 40-79 years of age are entered.

**10-year risk for ASCVD is categorized as:
Low-risk (<5%)
Borderline risk (5% to 7.4%)
Intermediate risk (7.5% to 19.9%)
High risk (≥20%)

Visit SummaryBelow is a summary of patient’s risk, treatment options, and treatment advice based on the data provided.

Email Advice
Print with Complete Treatment AdvicePrint

Treatment Advice*

Expand All

LDL-C Management (for this Patient)

Consider whether BP-lowering or LDL-C lowering, or both, is best approach.

Link to Full ACC/AHA Cholesterol Guideline
Link to Full ACC/AHA CV Risk Guideline

Tobacco Cessation (for this Patient)

Diabetes Mellitus Management (General)

Lifestyle Recommendations (General)

Nutrition and Diet
  • To reduce ASCVD risk in all patients:
    • - A diet emphasizing intake of vegetables, fruits, legumes, nuts, whole grains, and fish is recommended (I, B-R). A diet containing reduced amounts of cholesterol and sodium can be beneficial (IIa, B-NR).
    • - Replacement of saturated fat with dietary mono- and poly-unsaturated fats can be beneficial (IIa, B-NR).
    • - Minimizing the intake of trans fats, processed meats, refined carbohydrates, and sweetened beverages as part of a heart healthy diet is reasonable (IIa, B-NR).
  • For adults with type 2 diabetes mellitus:
    • - A tailored nutrition plan focusing on a heart-healthy dietary pattern is recommended to improve glycemic control, achieve weight loss (if needed), and improve other ASCVD risk factors (I, A).
Exercise and Physical Activity
  • To reduce ASCVD risk, adults should:
    • - Be routinely counseled to optimize a physically active lifestyle (I, B-R).
    • - Engage in at least 150 minutes per week of accumulated moderate intensity or 75 minutes per week of vigorous intensity aerobic physical activity (or an equivalent combination of moderate and vigorous activity) (I, B-NR). This includes adults with type 2 diabetes mellitus (I, A).
    • - Decrease sedentary behavior (IIb, C-LD).
  • For adults unable to meet the minimum physical activity recommendations:
    • - Engaging in some moderate or vigorous intensity physical activity, even if less than this recommended amount, can be beneficial to reduce ASCVD risk (IIa, B-NR).
      IntensityMETSExamples
      Sedentary Behavior*1-1.5 Sitting, reclining, or lying; watching TV
      Light1.6-2.9 Walking slowly, cooking, light house work
      Moderate3.0-5.9 Brisk walking (2.4-4mph), biking 5-9mph, ballroom dancing, active yoga, recreational swimming
      Vigorous≥6 Jogging/running, biking ≥10mph, singles tennis, swimming laps
      *Sedentary behavior is defined as any waking behavior characterized by an energy expenditure ≤1.5 metabolic equivalents (METs), while in a sitting, reclining, or lying posture. Standing is a sedentary activity in that it involves ≤1.5 METs, but is not considered a component of sedentary behavior; mph indicates miles per hour
Obesity and Being Overweight
  • In overweight and obese adults:
    • - Weight loss is recommended to improve the ASCVD risk-factor profile (I, B-R).
    • - Counseling and comprehensive lifestyle interventions, including calorie restriction, are recommended for achieving and maintaining weight loss (I, B-R).
    • - Calculating body mass index is recommended annually or more frequently to identify overweight and obese adults for weight loss considerations (I, C-EO).
    • - It is reasonable to measure waist circumference to identify those at higher cardiometabolic risk (IIa, B-NR).

Aspirin Use Recommendations (for this Patient)

Immunization Practice (General)

CDC's Standards for Adult Immunization Practice

  1. ASSESS the immunization status of all your patients at every clinical encounter.​
  2. StronglyRECOMMEND vaccines that your patients need.​
  3. ADMINISTER needed vaccines or REFER your patients to a vaccination provider.​
  4. DOCUMENT vaccines received by your patients.

Immunization Practice (for this Patient)​

Supporting Guideline Recommendation​

The pneumococcal vaccine is recommended for patients 65 years of age and older and in high-risk patients with cardiovascular disease. (1, B).​


CDC’s Recommendation for Patients 65 and older​

There are three flu vaccines that are preferentially recommended for people 65 years and older. These areFluzone High-Dose Quadrivalent vaccine,Flublok Quadrivalent recombinant flu vaccine andFluad Quadrivalent adjuvanted flu vaccine. This recommendation was based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines.​


CDC’s Standards for Adult Immunization Practice​

  1. ASSESS the immunization status of all your patients at every clinical encounter.​
  2. StronglyRECOMMEND vaccines that your patients need.​
  3. ADMINISTER needed vaccines or REFER your patients to a vaccination provider.​
  4. DOCUMENT vaccines received by your patients.

Therapy Safety Information (General)

See Resource Section of this app for full prescribing information.

  • Statins: There is moderate quality evidence that statins do not increase the overall risk of adverse events, but that they may increase the risk of diagnosis of type 2 diabetes in certain individuals.
  • Tobacco Cessation: Adverse effects of tobacco cessation therapies are generally poorly reported, and vary by drug.
  • Aspirin: There is high-quality evidence indicating that aspirin may increase the risk of major bleeding. A calculator for considering major bleeding risks and potential benefits of aspirin therapy for MI and stroke prevention is availablehere.
ASCVD Risk Profile
10-yr risk for first ASCVD event is:

  • Actual Risk
  • Projected Risk

Enter potential treatment scenarios on the "Therapy Impact" tab to plot them on the graph above as well.


*Projected Risk with the following therapies:
  • ASA = Start or continue taking aspirin
  • BP = Start, add, or intensify blood pressure medication
  • Ch = Manage cholesterol by starting or intensifying statin
  • Sm = Stop smoking for at least 2 years

Inputs


Inputs

  • Sex:Female
  • Race:White
    • ValuesPreviousCurrent Current
    Age:
    Total Cholesterol(mg/dL)(mmol/L)240
    HDL Cholesterol(mg/dL)(mmol/L)
    LDL Cholesterol(mg/dL)(mmol/L)
    Systolic Blood Pressure (mm Hg)98140
    Diastolic Blood Pressure (mm Hg)98140
    Diabetes:
    Smoker:
    Treatment for Hypertension:Yes
    Aspirin Therapy:
    Statin:
Note: These estimates mayunderestimate the 10-year and lifetime risk for persons from some race/ethnic groups, especially American Indians, some Asian Americans (e.g., of south Asian ancestry), and some Hispanics (e.g., Puerto Ricans), and mayoverestimate the risk for others, including some Asian Americans (e.g., of east Asian ancestry) and some Hispanics (e.g., Mexican Americans).
Because the primary use of these risk estimates is to facilitate the very important discussion regarding risk reduction through lifestyle change, the imprecision introduced is small enough to justify proceeding with lifestyle change counseling informed by these results.

*Disclaimer: The results and recommendations provided by this application are intended to inform but do not replace clinical judgment. Therapeutic options should be individualized and determined after discussion between the patient and their care provider.

Recommendations are designated with both a class of recommendation (COR) and a level of evidence (LOE). The class of recommendation indicates the strength of recommendation, encompassing the estimated magnitude and certainty of benefit in proportion to risk. The level of evidence rates the quality of scientific evidence supporting the intervention on the basis of the type, quantity, and consistency of data from clinical trials and other sources.

  Estimate Risk
  Determine Therapy Impact
Potential risk reduction impact of different therapies can only be calculated for patients 40-79 years of age at an initial visit.
  Estimate Risk
  Determine Therapy Impact
Potential risk reduction impact of different therapies can only be calculated for patients 40-79 years of age at an initial visit.
ASCVD Risk Estimator +
  • Estimate Risk
  • Therapy Impact
    • Potential risk reduction impact of different therapies can only be calculated for patients 40-79 years of age at an initial visit.
  • Advice
    • Advice section is accessible when required characteristics for patients 40-79 years of age are entered.

Resources

Clinician Resources

References

Clinician Resources

Patient Resources

References

Back to Resources

Clinician Resources

Patient Resources

References

Back to Resources

Understanding My Cardiovascular Risk

The "2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk" provides clear recommendations for estimating cardiovascular disease risk. Risk assessments are extremely useful when it comes to reducing risk for cardiovascular disease because they help determine whether a patient is at high risk for cardiovascular disease, and if so, what can be done to address any cardiovascular risk factors a patient may have. Here are the highlights of the guideline:

  • Risk assessments are used to determine the likelihood of a patient developing cardiovascular disease, heart attack or stroke in the future. In general, patients at higher risk for cardiovascular disease require more intensive treatment to help prevent the development of cardiovascular disease.

  • Risk assessments are calculated using a number of factors including age, gender, race, cholesterol and blood pressure levels, diabetes and smoking status, and the use of blood pressure-lowering medications. Typically, these factors are used to estimate a patient's risk of developing cardiovascular disease in the next 10 years. For example, someone who is young with no risk factors for cardiovascular disease would have a very low 10-year risk for developing cardiovascular disease. However, someone who is older with risk factors like diabetes and high blood pressure will have a much higher risk of developing cardiovascular disease in the next 10 years.

  • If a preventive treatment plan is unclear based on the calculation of risk outlined above, care providers should take into account other factors such as family history and level of C-reactive protein. Taking this additional information into account should help inform a treatment plan to reduce a patient's 10-year risk of developing cardiovascular disease.

  • Calculating the 10-year risk for cardiovascular disease using traditional risk factors is recommended every 4-6 years in patients 20-79 years old who are free from cardiovascular disease. However, conducting a more detailed 10-year risk assessment every 4-6 years is reasonable in adults ages 40-79 who are free of cardiovascular disease. Assessing a patient's 30-year risk of developing cardiovascular disease can also be useful for patients 20-59 years of age who are free of cardiovascular disease and are not at high short-term risk for cardiovascular disease.

  • Risk estimations vary drastically by gender and race. Patients with the same traditional risk factors for cardiovascular disease such as high blood pressure can have a different 10-year risk for cardiovascular disease as a result of their sex and race.

  • After care providers and patients work together to conduct a risk assessment, it's important that they discuss the implications of their findings. Together, patients and their care providers should weigh the risks and benefits of various treatments and lifestyle changes to help reduce the risk of developing cardiovascular disease.

Source: www.cardiosmart.org

Diet and Physical Activity Recommendations

The "2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk" provides recommendations for heart-healthy lifestyle choices based on the latest research and evidence. The guidelines focus on two important lifestyle choices--diet and physical activity--which can have a drastic impact on cardiovascular health. Here's what every patient should know about the latest recommendations for reducing cardiovascular disease risk through diet and exercise.

Diet

  • Diet is a vital tool for lowering cholesterol and blood pressure levels, which are two major risk factors for cardiovascular disease.
  • Patients with high cholesterol and high blood pressure levels should eat plenty of vegetables, fruits and whole grains and incorporate low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts into their diet. They should also limit intake of sweets, sugar-sweetened beverages and red meats.
  • There are many helpful strategies for heart-healthy eating, including the DASH diet and the USDA's Choose My Plate.
  • Patients who need to lower their cholesterol should reduce saturated and trans fat intake. Ideally, only 5-6% of daily caloric intake should come from saturated fat.
  • Patients with high blood pressure should consume no more than 2,400 mg of sodium a day, ideally reducing sodium intake to 1,500 mg a day. However, even reducing sodium intake in one's current diet by 1,000 mg each day can help lower blood pressure.
  • It's important to adapt the recommendations above, keeping in mind calorie requirements, as well as, personal and cultural food preferences. Nutrition therapy for other conditions like diabetes should also be considered. Doing so helps create healthy eating patterns that are realistic and sustainable.

Physical Activity

  • Regular physical activity helps lower cholesterol and blood pressure, reducing the risk for cardiovascular disease.
  • In general, adults should engage in aerobic physical activity 3-4 times a week with each session lasting an average of 40 minutes.
  • Moderate (brisk walking or jogging) to vigorous (running or biking) physical activity is recommended to reduce cholesterol levels.

Source: www.cardiosmart.org

Weight Management Recommendations

The "2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults" was created to reflect the latest research to outline best practices when it comes to treating obesity--a condition that affects more than one-third of American adults. These guidelines help address questions like "What's the best way to lose weight?" and "When is bariatric surgery appropriate?". Here is what every patient should know about the treatment of overweight and obesity:

  • Definition of obesity: Obesity is a medical condition in which excess body fat has accumulated to the extent that it can have an adverse effect on one's health. Obesity can be diagnosed using body mass index (BMI), a measurement of height and weight, as well as waist circumference. Obesity is categorized as having a BMI of 30 or greater. Abdominal obesity is defined as having a waist circumference greater than 40 inches for a man or 35 inches for a woman.

  • Benefits of weight loss: Obesity increases the risk for serious conditions such as cardiovascular disease, diabetes and death, but losing just a little bit of weight can result in significant health benefits. For an adult who is obese, losing just 3-5% of body weight can improve blood pressure and cholesterol levels and reduce the risk for cardiovascular disease and diabetes. Ideally, care providers recommend 5-10% weight loss for obese adults, which can produce even greater health benefits.

  • Weight loss strategies: There is no single diet or weight loss program that works best for all patients. In general, reduced caloric intake and a comprehensive lifestyle intervention involving physical activity and behavior modification tailored according to a patient's preferences and health status is most successful for sustained weight loss. Further, weight loss interventions should include frequent visits with health care providers and last more than one year for sustained weight loss.

  • Bariatric Surgery: Bariatric surgery may be a good option for severely obese patients to reduce their risk of health complications and improve overall health. However, bariatric surgery should be reserved for only the highest risk patients until more evidence is available on this issue. Present guidelines advise that weight loss surgery is only recommended for patients with extreme obesity (BMI ≥40) or in patients that have a BMI ≥35 in addition to a chronic health condition.

Source: www.cardiosmart.org

Blood Cholesterol Management Recommendations

The American College of Cardiology (ACC) and the American Heart Association (AHA) recently developed new standards for treating blood cholesterol. These recommendations are based on a thorough and careful review of the very latest, highest quality clinical trial research. They help care providers deliver the best care possible. This page provides some of the highlights from the new practice guidelines. The ultimate goal of the new cholesterol practice guidelines is to reduce a person's risk of heart attack, stroke and death. For this reason, the focus is not just on measuring and treating cholesterol, but identifying whether someone already has or is at risk for atherosclerotic cardiovascular disease (ASCVD) and could benefit from treatment.

What is ASCVD?

Heart attack and stroke are usually caused by atherosclerotic cardiovascular disease (ASCVD). ASCVD develops because of a build-up of sticky cholesterol-rich plaque. Over time, this plaque can harden and narrow the arteries.

These practice guidelines outline the most effective treatments that lower blood cholesterol in those individuals most likely to benefit. Most importantly, they were selected as the best strategies to lower cholesterol to help reduce future heart attack or stroke risk. Share this information with your health care provider so that you can ask questions and work together to decide what is right for you.

Key Points

Based on the most up-to-date and complete look at available clinical trial results:

  • Health care providers should focus on identifying those people who are most likely to have a heart attack or stroke and make sure they are given effective treatment to reduce their risk.

  • Cholesterol should be considered along with other factors known to make a heart attack or stroke more likely.

  • Knowing your risk of heart attack and stroke can help you and your health care provider decide whether you may need to take a medication—most likely a statin—to lower that risk.

  • If a medication is needed, statins are recommended as the first choice to lower heart attack and stroke risk among certain higher-risk patients based on an overwhelming amount of evidence. For those unable to take a statin, there are other cholesterol-lowering drugs; however, there is less research to support their use.

Evaluating Your Risk

Your health care provider will first want to assess your risk of ASCVD (assuming you don't already have it). This information will help determine if you are at high enough risk of a heart attack or stroke to need treatment.

To do this, your care provider will 1) review your medical history and 2) gauge your overall risk for heart attack or stroke. He/she will likely want to know:

  • whether you have had a heart attack, stroke or blockages in the arteries of your heart, neck, or legs.

  • your risk factors. In addition to your total cholesterol, LDL cholesterol, and HDL (so-called "good") cholesterol, your health care provider will consider your age, if you have diabetes, and whether you smoke and/or have high blood pressure.

  • about your lifestyle habits, other medical conditions, any previous drug treatments, and if anyone in your family has high cholesterol or suffered a heart attack or stroke at an early age.

A lipid or blood cholesterol panel will be needed as part of this evaluation. This blood test measures the amount of fatty substances (called lipids) in your blood. You may have to fast (not eat for a period of time) before having your blood drawn.

If there is any question about your risk of ASCVD, or whether you might benefit from drug therapy, your care provider may make additional assessments or order additional tests. The results of these tests can help you and your health care team decide what might be the best treatment for you. These tests may include:

  • Lifetime risk estimates —how likely you are to have a heart attack and stroke during your lifetime

  • Coronary artery calcium (CAC) score —a test that shows the presence of plaque or fatty build-up in the heart artery walls

  • High-sensitivity C-Reactive Protein (CRP) —a blood test that measures the amount of CRP, a marker of inflammation or irritation in the body; higher levels have been associated with heart attack and stroke

  • Ankle-brachial index (ABI) —the ratio of the blood pressure in the ankle compared to blood pressure in the arm, which can predict peripheral artery disease (PAD)

If you have very high levels of low-density lipoprotein (LDL or "bad") cholesterol, your care provider may want to find out if you have a genetic or familial form of hypercholesterolemia. This condition can be passed on in families.

Your Treatment Plan

Before coming up with a specific treatment plan, your care provider will talk with you about options for lowering your blood cholesterol and reducing your personal risk of atherosclerotic disease. This will likely include a discussion about heart-healthy living and whether you might benefit from a cholesterol-lowering medication.

Heart-Healthy Lifestyle

Adopting a heart-healthy lifestyle continues to be the first and best way to lower your risk of problems. Doing so can also help control or prevent other risk factors (for example: high blood pressure or diabetes). Experts suggest:

  • Eating a diet rich in vegetables, fruits, and whole grains ; this also includes low-fat dairy products, poultry, fish, legumes, and nuts; it limits intake of sweets, sugar-sweetened beverages and red meats.

  • Getting regular exercise ; check with your health care provider about how often and how much is right for you.

  • Maintaining a healthy weight .

  • Not smoking or getting help quitting .

  • Staying on top of your health , risk factors and medical appointments. For some people, lifestyle changes alone may not be enough to prevent a heart attack or stroke. In these cases, taking a statin at the right dose will most likely be necessary.

Medications

There are two types of cholesterol-lowering medications: statins and non-statins.

Statin Therapy

There is a large body of evidence that shows the use of a statin provides the greatest benefit and fewest safety issues. In particular, specific groups of patients appear to benefit most from taking moderate or high-intensity statin therapy. Based on this information, your care provider will likely recommend a statin if you have:

  • ASCVD

  • Very high LDL cholesterol (190 mg/dL or higher)

  • Type 2 diabetes and are between 40 and 75 years of age

  • Above a certain likelihood of having a heart attack or stroke in the next 10 years (7.5% or higher) and are between 40 and 75 years of age

In certain cases, your care provider may still recommend a statin even if you don't fit into one of the groups above. He/she will consider your overall health and other factors to help decide if you are at enough risk to benefit from a statin. Based on the guidelines, these may include:

  • Family history of premature heart attack or stroke

  • Your lifetime risk of ASCVD

  • LDL-cholesterol ≥160 mg/dL

  • hs-CRP ≥2 mg/L

  • Results from other special testing (CAC scoring, ABI)

If you are on a statin, your care provider will need to find the dose that is right for you.

  • People who have had a heart attack, stroke or other types of ASCVD tend to benefit the most from taking the highest amount (dose) of statin therapy if they tolerate it. This may be more appropriate than taking multiple drugs to lower cholesterol.

  • A more moderate dose of statin may be appropriate for some people with ASCVD, such as those over 75 years or those that might have problems taking the highest dose of a statin (i.e., those with prior organ transplantation).

Sometimes more than one statin needs to be tried before finding the one that works best.

If you are 75 years or older and have not already had a heart attack, stroke or other types of ASCVD, your care provider will discuss whether a statin is right for you.

Other cholesterol-lowering medications

Not all patients will be able to take the optimum dose of statin. After attention to lifestyle changes and statin therapy, non-statin drugs may be considered if you have high-risk with known ASCVD, diabetes, or very high LDL cholesterol values (≥190 mg/dL) and:

  • Have side effects from statins that prevent you from getting to the optimal dose or are not able to take a statin at all.

  • Are limited from taking an optimal dose due to other drugs that you are taking, including:

    • Transplant drug regimens to prevent rejection

    • Multiple drugs to treat HIV

    • Some antibiotics like erythromycin and clarithromycin or certain oral anti-fungal drugs

As always, it's important to talk with your health care provider about which medication is right for you.

What About Having Goals of Treatment?

Although keeping LDL-cholesterol lower with an optimal dose of statin is supported strongly by clinical trials, getting to a specific goal level is not.

Staying on Top of Your Risk

  • Take steps to lower your risk factors for heart attack, stroke and other problems —Make healthy choices (eating a healthy diet, getting exercise, maintaining a healthy weight and not smoking). Drug therapy, if needed, can help control risk factors.

  • Report side effects —Muscle aches are commonly reported and may or may not be due to the statin. If you are having problems, your care provider needs to know to help manage any side effects and possibly switch you to a different statin.

  • Take your medications as directed .

  • Get blood cholesterol and other tests that are recommended by your health care team. These can help assess whether statin therapy—and the dose—is working for you.

Questions to Ask

  • What are my risk factors for heart attack and stroke? Am I on the best prevention program to minimize this risk?

  • Is my cholesterol high enough that it might be due to a genetic condition?

  • What lifestyle changes can I make to stay healthy and prevent problems?

  • Do I need to be on a statin?

  • How do I monitor how I am doing?

  • What should I do if I develop muscle aches or weakness after starting the statin?

  • What do I do if I have other symptoms after starting the statin?

Source: www.cardiosmart.org

Groups that Benefit from Statin Therapy Infographic

Groups that benifit from Statins

Common Cardiovascular TermsAlphabetical Glossary

    For additional cardiovascular terms visit www.cardiosmart.org

    Terms

    ASCVD Risk Estimator Plus Terms of Service and License Agreement

    This Terms of Service and License Agreement constitutes a legal agreement (collectively, the "Agreement") between the American College of Cardiology Foundation ("ACCF") and You and your agents ("You") for the use of ASCVD Risk Estimator Plus (the "Product"), whether You use the mobile application version of the Product or the web version of the Product. The Product allows You to access certain content included in the Product ("Content") relating to calculation of ASCVD Risk and corresponding guideline advice.

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    This Product, including the information, text, graphics, images, audio and video files, trademarks and other materials that may be contained therein (collectively "Content"), is owned by ACCF and/or its suppliers and is protected by patents, copyrights, trademarks, and other proprietary rights. Except as specifically provided in this Agreement, your use of the Product shall be governed and constrained by applicable patent, copyright, trademark and other intellectual property laws. ACCF grants You a limited, nonexclusive, nontransferable, revocable license to utilize and access the Product for your noncommercial, personal use according to the terms and conditions in this Agreement. You may not modify, publish, transmit, participate in the transfer or sale of, reproduce, create derivative works from, distribute, perform, display, incorporate into another website, or in any other way exploit the Service and/or any of the Content, in whole or in part. Except as expressly granted by this Agreement, You acquire no right, title or interest in the Product or the Content or other data or materials incorporated in the Product. ACCF, ACC or affiliates or licensors thereof shall retain all right, title and interest in the Product and Content.


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    Release of Liability

    You assume all risks associated with use of the Product including, but not limited to any harm, injury or damages resulting directly or indirectly from the use of the Product, all such risks being known and understood by You. In consideration of your use of the Product, You, for yourself and anyone entitled to act on your behalf, waive and forever release ACCF, its officers, trustees, employees, representatives and successors from all claims and liabilities of any kind arising out of your use or misuse of the Product.


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    The Content on the Product is presented as an educational service intended for licensed healthcare professionals. While the Content in the Product is about specific medical and healthcare issues, the Content is not a substitute for or replacement of personalized medical advice and is not intended to be used as the sole basis for making individualized medical or health-related decisions.

    The views and opinions expressed are those of the contributing authors and editors and do not necessarily represent the views of the ACCF. The material is not intended to present the only, or necessarily best, methods or procedures for the medical situations addressed, but rather is intended to represent an approach, view, statement or opinion.

    Any reference to a specific therapy or commercial product in this Product does not constitute a guarantee or endorsement by ACCF of the quality or value of such therapy or product or any claims made by the manufacturer of such therapy or commercial product.

    In addition, any statements about such therapy or commercial products are solely based on published clinical prediction rules and estimates of drug treatment effects from published clinical studies and do not represent an ACCF endorsement or evaluation of these products.


    Force Majeure

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    I hereby certify that I understand and agree to the terms stated in this Agreement and that this Agreement applies to my initial use of the Product and all other subsequent uses of the Product. BY USING THIS PRODUCT, I HEREBY AFFIRM THAT I HAVE READ, FULLY UNDERSTAND, AND AGREE TO THE ABOVE STATEMENTS.

    About the App

    This app was last updated:

    August 2025

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    Target patient population:

    The Risk Estimator is intended for use in patients at risk for atherosclerotic coronary artery disease (ASCVD) and ASCVD-related events, especially due to dyslipidemia and hypertension.

    The why and how of risk assessment*

    When considering drug therapy for primary prevention of ASCVD, clinicians and patients should begin by calculating the 10-year and lifetime ASCVD risk estimates to identify patients in higher-risk groups who are likely to have greater net benefit and lower number needed to treat for both statins and antihypertensive therapy. Current U.S. prevention guidelines for cholesterol management recommend use of the pooled cohort equations (PCE) to assess 10-year ASCVD risk and start a process of shared decision-making between clinicians and patients. Lifetime risk assessment appears to be particularly useful for describing and communicating ASCVD risk in younger individuals. The Million Hearts Longitudinal ASCVD Risk Assessment equation can also be used to update a patient’s risk by comparing change in risk factors from a previous to the current visit. (See “Terms and Concepts” in the Resources section for more information about each of these calculations and where they are utilized in the app.)

    The guidelines recommend the use of the PCE as an important starting point, but not as the final arbiter, for decision-making in primary prevention of ASCVD. The initial risk estimate should form the basis for a discussion that includes:

    • - Burden and severity of CVD risk factors and control of these risk factors.
    • - Presence of risk-enhancing conditions (See “ASCVD Risk Enhancing Factors” in the Resources section at the bottom of this app). It is difficult to determine how much a risk-enhancing factor may change a patient’s 10-year risk estimate quantitatively and therefore, clinician judgment is also crucial to determine whether factors are significant enough to reclassify an individual’s risk category.
    • - Adherence to healthy lifestyle recommendations. For all patients, appropriate lifestyle modification should be recommended. In patients at higher absolute predicted risk for ASCVD (typically, a 10-year estimated risk) more intensive lifestyle efforts are recommended.
    • - Potential for ASCVD risk-reduction benefits from statins and antihypertensive drug therapy, and the potential for adverse effects and drug–drug interactions. The Million Hearts Longitudinal ASCVD Risk Assessment equations can also help to quantify potential benefits of preventive therapies based on high-quality evidence, and can be accessed in the Therapy Impact tab at the top of this app.
    • - Patient preferences regarding the use of medications for primary prevention. In addition, in patients at intermediate 10-year risk (7.5% to <20%), and select patients at borderline risk (5% to <7.5%) for whom, after the clinician-patient discussion, the benefits of statin medication for the individual patient remain unclear, the patient has important risk-modifying factors that suggest a better or worse risk than the original estimate, or if the patient is undecided regarding drug therapy, additional testing to help with the decision making is reasonable. In such cases, additional testing should only be used if it can provide sufficient information to modify the decision. Presently, the best additional test to help reclassify ASCVD risk in these situations is measurement of a CAC score for decision-making regarding statin therapy. Please see “Using A CAC Score to Inform Decision Making” in the Resources section at the bottom of this app for more information.

    How to use this app for risk assessment:

    The ASCVD Risk Estimator Plus helps clinicians implement guideline-recommended risk equations to facilitate clinician-patient discussion and support decision making to optimize care and lower risk for atherosclerotic cardiovascular disease (ASCVD). Clinicians and patients should weigh and incorporate the information provided by this app in the context of other considerations, including recommended lifestyle interventions, patient preferences for taking medications, potential adverse drug reactions or interactions, and which treatment intervention approach might be most successful for a particular patient.

    Estimate Screen:Estimate and monitor patient’s 10-year risk for atherosclerotic cardiovascular disease

    Users can choose to calculate a patient’s 10-year ASCVD in two ways:

    • Enter today’s data to calculate a patient’s current 10-year ASCVD risk using the pooled cohort equation. This is most appropriate if this is the first time you are seeing a patient at an initial visit.
    • Enter data from both today and a previous visit. This allows the app to calculate a patient’s previous risk for comparison, and also more precisely adjust today’s ASCVD risk by factoring in change in a patient’s risk factors over time using the Million Hearts Longitudinal Assessment tool. This is most appropriate if you have seen a patient before.

    Therapy Impact tab:Form a risk-lowering intervention plan with your patient at an initial visit

    • “Review Therapy Advice”: Review evidence-based suggestions on an intervention strategy to help discuss a risk-lowering treatment plan with your patient.
    • “Select Therapy(s)”:As part of the discussion, enter different therapy combinations to view the projected impact those therapies might have on a patient’s ASCVD risk.

    Advice Screen:Pull it all together

    • “Estimated 10-Year ASCVD Risk Profile”: Visualize the change in risk over time the forecasted risk of different treatment scenarios calculated on the previous screens, and compare to the optimal risk that can be achieved for this patient, in one summary graphic. To turn this graphic into a handout for your patient, take a screen shot, save, and print.
    • “Treatment Advice Summary”: Review an expanded version of the evidence-based advice provided on the Forecast screen, including treatment safety information and supporting guideline recommendations.
    • “Inputs”: Capture a summary of the patient parameters entered into the app.
    • “Email”:Email yourself a summary of the calculated ASCVD risk, treatment suggestions, and patient inputs to use as a patient handout or to include in your records for this patient.

    Resources Screen:Visit this tab in the app for

    • A sample practice scenario for how to use this app with a patient
    • Definitions of key terms, concepts, and calculations in the app
    • Related tools and informational resources for both clinicians and patients
    • Links to reference documents

    What has changed and what remains the same in the new ASCVD Risk Estimator Plus:

    In addition to an upgrade to the app look and feel, the name “ASCVD Risk Estimator Plus” refers to the fact that this new version combines the original ASCVD Risk Estimator functionality plus the 2016 Million Hearts Longitudinal ASCVD Risk Assessment tool, published in 2016.

    ASCVD Risk Estimator Plus maintains the same functionalities as the original ASCVD Risk Estimator (e.g., 10-year risk via the Pooled Cohort equation can be calculated under Initial Visits on the Evaluate screen). However, the app now includes additional capabilities to estimate and track change in risk over time, and forecast potential benefit of specific risk-lowering interventions. (See “Terms and Concepts” in the “Resources” section of this app for more information on how each individual value is calculated.) The ASCVD Risk Estimator Plus has also expanded the guidance provided by including expert advice regarding aspirin use, smoking cessation, along with the original statin recommendations.

    Lastly, the ASCVD Risk Estimator Plus now allows the option to calculate initial 10-year ASCVD risk for patients who have already initiated a statin, “Initial 10-year ASCVD risk" may be calculated for patients who have already initiated statin therapy because recent evidence suggests a patient’s cholesterol values have the same impact on ASCVD risk regardless of whether current values were achieved with or without the aid of statin therapy.

    How was this App developed?

    The App was designed and vetted through collaboration with the authors of the source documents listed above, as well as other ACC clinical members. It was further refined via user testing with physicians, nurse practitioners, and pharmacists.

    *Adapted from Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC Jr, Sperling LS, Virani SS, Blumenthal RS. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: a special report from the American Heart Association and American College of Cardiology; JACC Nov 2018, 25711; DOI:10.1016/j.jacc.2018.11.005

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    Table 6. Risk-Enhancing Factors for Clinician–Patient Risk Discussion

    Risk-Enhancing Factors
    • Family history of premature ASCVD(males, age <55 y; females, age <65 y)
    • Primary hypercholesterolemia (LDL-C, 160–189 mg/dL [4.1–4.8 mmol/L); non–HDL-C 190–219 mg/dL [4.9–5.6 mmol/L])*
    • Metabolic syndrome (increased waist circumference, elevated triglycerides [≥150 mg/dL], elevated blood pressure, elevated glucose, and low HDL-C [<40 mg/dL in men; <50 in women mg/dL] are factors; tally of 3 makes the diagnosis)
    • Chronic kidney disease (eGFR 15–59 mL/min/1.73 m2 with or without albuminuria; not treated with dialysis or kidney transplantation)
    • Chronic inflammatory conditionssuch as psoriasis, RA, or HIV/AIDS
    • History of premature menopause (before age 40 y) and history of pregnancy-associated conditions that increase later ASCVD risk such as preeclampsia
    • High-risk race/ethnicities(e.g., South Asian ancestry)
    • Lipid/biomarkers:Associated with increased ASCVD risk
      • Persistently* elevated, primary hypertriglyceridemia (≥175 mg/dL);
      • If measured:
        • Elevated high-sensitivity C-reactive protein(≥2.0 mg/L)
        • Elevated Lp(a):A relative indication for its measurement is family history of premature ASCVD. An Lp(a) ≥50 mg/dL or ≥125 nmol/L constitutes a risk-enhancing factor especially at higher levels of Lp(a).
        • Elevated apoB≥130 mg/dL: A relative indication for its measurement would be triglyceride ≥200 mg/dL. A level ≥130 mg/dL corresponds to an LDL-C >160 mg/dL and constitutes a risk-enhancing factor
        • ABI <0.9

    *Optimally, 3 determinations.

    AIDS indicates acquired immunodeficiency syndrome; ABI, ankle-brachial index; apoB, apolipoprotein B; ASCVD, atherosclerotic cardiovascular disease; eGFR, estimated glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; HIV, human immunodeficiency virus; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein (a); and RA, rheumatoid arthritis.

    Table 5. Diabetes-Specific Risk Enhancers Independent of Other Risk Factors in Diabetes Mellitus

    Risk Enhancers
    • Long duration (≥10 years for type 2 diabetes mellitus or ≥20 years for type 1 diabetes mellitus)
    • Albuminuria ≥30 mcg of albumin/mg creatinine
    • eGFR <60 mL/min/1.73 m2
    • Retinopathy
    • Neuropathy
    • ABI* <0.9

    *ABI indicates ankle-brachial index; and eGFR, estimated glomerular filtration rate.

    Heaviness of Smoking Index:

    Use to assess degree of nicotine dependence to help guide intensity of treatment.

    How many cigarettes do you smoke?
    AnswerScore
    10 or fewer0
    11-201
    21-302
    ≥ 313
    How soon after waking up do you smoke your first cigarette of the day?
    AnswerScore
    After 60 minutes0
    31-60 minutes1
    6-30 minutes2
    Within 5 minutes3
    Level of nicotine dependence is computed by adding the scores together
    ScoreLevel of Nicotine Dependence
    0-2Low
    3-4Moderate
    5-6High
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