From the Guidelines
The ASCVD risk calculator should be used for adults aged 40-75 years without existing cardiovascular disease to estimate their 10-year risk of heart attack or stroke, as recommended by the 2019 ACC/AHA guideline 1. This calculator is particularly important when making decisions about starting statin medications for primary prevention. The calculator incorporates key factors including age, gender, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure treatment status, diabetes status, and smoking status. You should use this tool during routine health check-ups, when considering preventive therapies, or when cardiovascular risk factors are identified. Some key points to consider when using the ASCVD risk calculator include:
- For patients with borderline risk (5-7.5%), additional risk enhancers like family history or elevated inflammatory markers may help guide decision-making.
- The calculator helps implement a shared decision-making approach between clinicians and patients regarding statin therapy, with high-intensity statins typically recommended for those with risk ≥7.5%, and moderate-intensity statins for those with risk between 5-7.5% who have additional risk factors.
- The calculator works by using population-based data to estimate individual risk, allowing for more personalized preventive care strategies.
- Coronary artery calcium scoring can be used to reclassify ASCVD risk and personalize individual therapy, especially for intermediate-risk patients 2.
- The presence or absence of coronary artery calcium is a powerful prognostic indicator that can help physicians reclassify patient risk status when appropriate 3. Some of the key factors that can influence the decision to use the ASCVD risk calculator include:
- Age: The calculator is recommended for adults aged 40-75 years without existing cardiovascular disease.
- Cardiovascular risk factors: The calculator should be used when considering preventive therapies or when cardiovascular risk factors are identified.
- Statin therapy: The calculator can help guide decision-making about starting statin medications for primary prevention.
- Coronary artery calcium scoring: This can be used to reclassify ASCVD risk and personalize individual therapy, especially for intermediate-risk patients. Overall, the ASCVD risk calculator is a useful tool for estimating individual risk and guiding preventive care strategies, and should be used in conjunction with clinical judgment and patient preferences.
From the Research
When to Use the ASCVD Calculator
The ASCVD calculator is used to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) in adults. According to the study 4, the American College of Cardiology/American Heart Association (ACC/AHA) recommends using the ASCVD pooled cohort equations to estimate risk in patients ages 40 to 79 years.
Indications for ASCVD Risk Assessment
The following are indications for using the ASCVD calculator:
- Adults aged 40 to 79 years 4
- Patients with known ASCVD or those at high risk of developing ASCVD 5
- Individuals with intermediate risk (10-year ASCVD risk of 7.5% to less than 20%) who may benefit from statin therapy 4
Factors to Consider When Using the ASCVD Calculator
When using the ASCVD calculator, the following factors should be considered:
- Traditional risk factors such as age, sex, cholesterol levels, blood pressure, and smoking status 5
- Novel biomarkers and inflammatory factors that can enhance ASCVD risk assessment 5
- Female-specific risk enhancers and social determinants of health 5
- Presence of subclinical atherosclerosis, such as coronary artery calcium assessed by computed tomography 4, 5
Clinical Practice Guidelines
Current clinical practice guidelines recommend the following:
- Using the ASCVD calculator to estimate 10-year ASCVD risk in adults aged 40 to 79 years 4
- Offering statin therapy to patients with a 10-year ASCVD risk of 20% or higher 4
- Discussing the potential benefits of statin therapy with patients who have an intermediate risk (10-year ASCVD risk of 7.5% to less than 20%) 4
- Considering additional risk-enhancing factors and novel biomarkers to inform treatment decisions 5