Calculating the 10-Year ASCVD Risk Score
To calculate the 10-year ASCVD risk score, you should use the ACC/AHA Pooled Cohort Equations (PCE) calculator, which is the standard tool recommended by major cardiovascular guidelines. 1
Required Information for ASCVD Risk Calculation
To calculate the 10-year ASCVD risk score, you need the following patient information:
- Age (40-79 years)
- Sex
- Race (specifically whether the patient is African American or not)
- Total cholesterol level
- HDL cholesterol level
- Systolic blood pressure
- Treatment status for hypertension (yes/no)
- Diabetes status (yes/no)
- Smoking status (current smoker: yes/no)
How to Calculate the Risk Score
Access the ACC/AHA ASCVD Risk Estimator Plus online tool at: http://tools.acc.org/ASCVD-Risk-Estimator-Plus
Enter all required patient data into the calculator
The calculator will provide:
- 10-year risk of a first ASCVD event
- Lifetime risk (for patients 20-59 years)
- Risk category classification
Risk Categories and Clinical Implications
The 10-year ASCVD risk is categorized as follows 1, 2:
- Low risk: <5%
- Borderline risk: 5% to <7.5%
- Intermediate risk: 7.5% to <20%
- High risk: ≥20%
Clinical Application of Risk Score Results
The risk score guides several important clinical decisions:
Blood Pressure Management:
- For patients with diabetes and hypertension with ASCVD risk ≥15%: target BP <130/80 mmHg
- For patients with diabetes and hypertension with ASCVD risk <15%: target BP <140/90 mmHg 1
Statin Therapy Consideration:
- For intermediate risk (≥7.5% to <20%): Consider statin therapy
- For borderline risk (5% to <7.5%): May consider statin therapy if risk-enhancing factors are present 1
Additional Risk Assessment:
- For intermediate or borderline risk: Consider coronary artery calcium scoring to further refine risk assessment 1
Important Considerations and Limitations
- The calculator is validated for adults aged 40-79 years without existing ASCVD
- For adults 20-39 years, consider lifetime risk assessment 1
- The calculator may overestimate risk in certain populations 1
- The calculator does not account for diabetes duration or complications such as albuminuria 1
- The newer PREVENT equations (2023) tend to estimate lower risk compared to PCE but are not yet incorporated into major guidelines 3
Risk Modification
After calculating risk, discuss modifiable risk factors with the patient:
- Dietary changes (DASH diet can reduce 10-year ASCVD risk by approximately 10%) 4
- Physical activity (low physical activity is associated with higher risk) 5
- Smoking cessation
- Alcohol moderation (regular drinkers have significantly higher ASCVD risk) 5
By accurately calculating and interpreting the 10-year ASCVD risk score, you can make evidence-based decisions about preventive interventions to reduce cardiovascular morbidity and mortality.