ACC/AHA Pooled Cohort Equations — ASCVD Risk
Estimates 10-year risk of first atherosclerotic cardiovascular event (MI or fatal CVD) in patients without prior ASCVD. Guides statin therapy decisions.
Score interpretation
Estimated 10-year ASCVD risk <5%.
→ Lifestyle modification. Statins generally not indicated unless risk-enhancing factors present.
Estimated 10-year ASCVD risk 5% to <7.5%. Statin therapy may be beneficial.
→ Clinician-patient risk discussion. Consider moderate-intensity statin if risk-enhancing factors present. Lifestyle optimisation.
Estimated 10-year ASCVD risk 7.5% to <20%. Moderate-intensity statin recommended.
→ Moderate-intensity statin (atorvastatin 10–20 mg or rosuvastatin 5–10 mg). Treat modifiable risk factors. Consider coronary artery calcium (CAC) scoring if uncertain.
Estimated 10-year ASCVD risk 20% or more.
→ High-intensity statin (atorvastatin 40–80 mg or rosuvastatin 20–40 mg). Blood pressure and diabetes control. Consider additional lipid-lowering (ezetimibe, PCSK9 inhibitor) if LDL remains elevated.
Interpretation bands for the ASCVD Risk. Apply clinical judgement and local guidance.
References
- Goff DC Jr et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation. 2014;129(25 Suppl 2):S49-73.
- Grundy SM 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.
- Arnett DK, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140(11):e596–e646.
Related
Curated clinical cross-links plus same-class fallbacks.
- Framingham Risk Score · Cardiovascular Risk
- PREVENT Cardiovascular Risk Calculator (AHA/ACC 2023) · Cardiovascular Risk
- Reynolds Risk Score for Women · Cardiovascular Risk
- SCORE2 — 10-Year CVD Risk (Age 40–69) · Cardiovascular Risk
- SCORE2-OP — 5/10-Year CVD Risk (Age ≥ 70) · Cardiovascular Risk
- SCORE2-Diabetes 10-Year CVD Risk in Type 2 Diabetes · Cardiovascular Risk
- Atorvastatin (CKD Cardiovascular Risk) · Cardiovascular Risk in CKD
- Icosapent Ethyl (Omega-3 — Cardiovascular Risk Reduction) · Omega-3 Fatty Acid (Purified EPA — Eicosapentaenoic Acid Ethyl Ester)
- Fluvastatin · HMG-CoA reductase inhibitor (statin)
- Pravastatin sodium · HMG-CoA reductase inhibitor (hydrophilic statin)
- Tenecteplase · Cardiovascular Emergency
- Tirofiban · Cardiovascular Emergency
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.