Estimate your 10-year risk of heart attack or stroke using the ACC/AHA Pooled Cohort Equations (PCE). The same tool used in clinical practice to guide statin therapy decisions.
The ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator estimates your 10-year probability of experiencing a first cardiovascular event, specifically a heart attack (myocardial infarction) or stroke. It uses the Pooled Cohort Equations (PCE), which were developed from multiple large, long-running population studies and published by the American College of Cardiology and American Heart Association (ACC/AHA) in 2013.
This is the tool the ACC/AHA guidelines recommend that clinicians use in clinical practice to guide decisions about statin therapy and other preventive interventions. It replaced the older Framingham Risk Score as the primary risk assessment tool in the United States. If your doctor has ever discussed your "heart attack risk" or whether you should start a statin, they almost certainly used this calculator or one based on the same equations.
The PCE use a Cox proportional hazards model with seven clinical variables: age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure (and whether it's treated), smoking status, and diabetes status. The equations take natural-log transforms of the continuous variables (age, cholesterol, HDL, blood pressure) and apply sex- and race-specific coefficient sets to calculate a weighted risk score.
Four separate models are used: one each for White males, White females, Black males, and Black females. These distinct coefficient sets reflect the different baseline cardiovascular risk profiles observed in the original cohort studies (Framingham Heart Study, ARIC, CARDIA, CHS, and others). The "White/Other" model is applied to individuals of other racial and ethnic backgrounds, though the PCE were not specifically validated in Hispanic, Asian, or other populations.
The core formula is: Risk = 1 - S10exp(sum of weighted coefficients - group mean), where S10 is the 10-year baseline survival probability for each demographic group. The calculator on this page implements the exact coefficients published in the original 2013 paper by Goff et al. in the Journal of the American College of Cardiology.
The 2018 ACC/AHA Guideline on the Management of Blood Cholesterol defines four 10-year ASCVD risk tiers that guide treatment decisions:
Low risk (below 5%): Lifestyle modification is the primary recommendation. Statins are generally not indicated unless LDL cholesterol is very high (190+ mg/dL) or there are significant risk-enhancing factors.
Borderline risk (5-7.4%): The "gray zone." Risk-enhancing factors (family history of premature CVD, South Asian ancestry, metabolic syndrome, chronic kidney disease, inflammatory conditions, elevated triglycerides, elevated CRP, elevated Lp(a)) may tip the decision toward statin therapy. A coronary artery calcium (CAC) score can help: a score of zero generally supports deferring treatment, while a positive score strengthens the case for starting a statin.
Intermediate risk (7.5-19.9%): The guidelines recommend a clinician-patient discussion about starting moderate-intensity statin therapy. This is the most common category where the CAC score adds the most value for shared decision-making. Use our CT Calcium Score Calculator to understand your CAC results in context.
High risk (20% or above): High-intensity statin therapy is recommended. Most patients in this category have multiple significant risk factors. The benefit of treatment is well-established and the guidelines recommend initiating therapy without further testing.
The ASCVD calculator complements several other tools on MayoCalc. If your ASCVD risk falls in the borderline or intermediate range, a CT Calcium Score can refine the decision. The MESA 10-Year CHD Risk Calculator uses a different model that includes the calcium score directly in the equation, providing an alternative risk estimate for patients who have had a cardiac CT.
Blood pressure is a key input to this calculator. If your systolic blood pressure is above 130, see our guide to lowering blood pressure naturally for evidence-based interventions that can reduce your numbers. Check your blood pressure category to understand what your reading means under the current 2025 AHA/ACC guidelines.
For cholesterol interpretation and understanding what your total cholesterol, LDL, and HDL numbers mean, see our guide to reading blood test results. For a broader understanding of cardiovascular risk, our calcium score guide and MESA risk score guide provide detailed explanations of how these clinical tools work together.
The PCE are the best-validated general population cardiovascular risk tool in the United States, but they have important limitations. They are known to overestimate risk in some populations, particularly in lower-risk individuals, contemporary cohorts (since cardiovascular event rates have declined since the original studies), and populations outside the United States. Several studies have shown that the PCE overestimate risk by 20-50% in certain groups.
The equations also do not account for several factors known to affect cardiovascular risk: family history of premature heart disease, chronic kidney disease, South Asian ancestry, inflammatory conditions (like rheumatoid arthritis), elevated lipoprotein(a), and coronary artery calcium. The 2018 ACC/AHA guidelines explicitly recommend considering these "risk-enhancing factors" when the calculated risk is borderline or intermediate, and using CAC scoring to reclassify patients when the treatment decision is uncertain.
This calculator is validated for ages 40-79 only. For individuals under 40, a lifetime risk approach may be more appropriate. For those over 79, the decision to initiate or continue statin therapy is typically based on clinical judgment, life expectancy, and patient preferences rather than a 10-year risk calculation.
To get the most accurate result, use laboratory-measured values from a recent fasting lipid panel (within the past year) rather than estimates. Your total cholesterol and HDL cholesterol should come from a blood test, not a guess. If you don't have recent labs, ask your doctor to order a fasting lipid panel at your next visit. Many primary care providers check these routinely at annual physicals for patients over 40.
For blood pressure, use the average of your last 2-3 readings taken in a clinical setting (sitting, rested, feet flat on the floor). A single reading at the pharmacy or at home can be 10-15 mmHg off from your true resting blood pressure due to white-coat effect, stress, caffeine, or recent activity. If you monitor at home, average your morning readings over a week for the most reliable number.
The "On Blood Pressure Medication" input matters because the equations adjust for the fact that treated blood pressure may underrepresent the underlying cardiovascular burden. A person with a systolic BP of 130 on medication likely has more vascular damage than a person who is naturally at 130, because the medication is masking a higher baseline. Selecting "Yes" appropriately increases the calculated risk.
If your risk is low (below 5%): Continue healthy lifestyle habits. The most important modifiable factors are not smoking, exercising 150+ minutes per week, eating a heart-healthy diet (DASH or Mediterranean), maintaining a healthy weight, and managing blood pressure below 130/80. Reassess your risk every 4-6 years or sooner if risk factors change.
If your risk is borderline (5-7.4%): This is where the conversation with your doctor becomes important. The 2018 guidelines identify several "risk-enhancing factors" that can tip the decision toward treatment: family history of premature ASCVD (heart attack or stroke in a first-degree male relative before age 55 or female relative before age 65), South Asian ancestry, metabolic syndrome, chronic kidney disease (eGFR below 60), inflammatory conditions like rheumatoid arthritis or lupus, premature menopause (before age 40), pregnancy complications (pre-eclampsia), elevated triglycerides (175+ mg/dL), elevated high-sensitivity CRP (2.0+ mg/L), elevated lipoprotein(a) (50+ mg/dL or 125+ nmol/L), and elevated apoB (130+ mg/dL). If any of these apply, your true risk may be higher than the PCE estimates. A coronary artery calcium (CAC) scan can provide additional data: a score of zero generally supports deferring statin therapy, while a score above 100 or above the 75th percentile for your age/sex strongly favors starting treatment. Use our CT Calcium Score Calculator to interpret CAC results.
If your risk is intermediate (7.5-19.9%): The ACC/AHA guidelines recommend discussing moderate-intensity statin therapy with your provider. This is the range where the decision is most nuanced and where shared decision-making matters most. Factors that favor starting a statin: risk-enhancing factors listed above, a CAC score above zero (especially above 100), or LDL cholesterol above 160 mg/dL. Factors that may support deferring: a CAC score of zero, no risk-enhancing factors, strong preference to avoid medication, or concerns about statin side effects that warrant a trial of intensive lifestyle modification first.
If your risk is high (20% or above): The guidelines recommend high-intensity statin therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg). At this risk level, the net benefit of statin therapy is well-established, with an expected 25-35% reduction in cardiovascular events over 5 years. Discuss with your provider whether additional therapies (ezetimibe, PCSK9 inhibitors) are warranted based on your LDL response to the initial statin.
The Framingham Risk Score was the previous standard in the U.S. It predicts "hard CHD" (heart attack and CHD death) but does not include stroke, which the PCE does. The PCE is considered the successor to Framingham for U.S. clinical practice.
The MESA CHD Risk Calculator (also available on MayoCalc as the MESA Risk Calculator) incorporates the coronary artery calcium score directly into the risk equation. If you've had a cardiac CT and know your calcium score, MESA provides a more refined estimate than the PCE alone because calcium scoring adds significant predictive value beyond traditional risk factors.
The SCORE2 and SCORE2-OP calculators are the European equivalents, recommended by the European Society of Cardiology (ESC). They use European-specific cohort data and different endpoints. If you live in Europe or have European ancestry, your cardiologist may prefer SCORE2 over the PCE.
The Reynolds Risk Score adds high-sensitivity CRP and family history to the traditional risk factors. It may be more accurate for women and for patients with inflammatory conditions, but it is not endorsed in the current ACC/AHA guidelines.
This calculator has been validated against the reference test case published in the original 2013 ACC/AHA paper (Goff et al., Table 4). The test case specifies a 55-year-old patient with total cholesterol of 213 mg/dL, HDL cholesterol of 50 mg/dL, untreated systolic blood pressure of 120 mmHg, no smoking, and no diabetes. The published expected results are: White male 5.3%, White female 2.1%, Black male 6.1%, and Black female 3.0%. This calculator reproduces all four values within 0.1 percentage points of the published figures.
The coefficients implemented here are the exact values from Table 4 of the original paper, including the Ln(Age)-squared term (coefficient 4.884) that applies only to the White/Other female equation. The four baseline survival probabilities (S10) and group means are taken directly from the same table. No modifications, simplifications, or approximations have been applied to the published equations.
For a complete, plain-English explanation of what your ASCVD risk score means and what to do about it, including the 2026 guideline changes, see our ASCVD risk score guide.
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. J Am Coll Cardiol. 2014;63(25 Pt B):2935-2959.
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. J Am Coll Cardiol. 2019;73(24):e285-e350.
Lloyd-Jones DM, Braun LT, Ndumele CE, et al. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease. J Am Coll Cardiol. 2019;73(24):3153-3167.