MDCalc

ASCVD (Atherosclerotic Cardiovascular Disease) 2013 Risk Calculator from AHA/ACC

Determine 10-year risk of hard ASCVD, i.e. myocardial infarction, stroke, or death due to coronary heart disease or stroke.

  • This calculator includes inputs based on race, which may or may not provide better estimates, so we have decided to make race optional. See here for more on our approach to addressing race and bias on MDCalc.
  • This tool often estimates higher risk for Black/African American adults than for other groups with the same profile, but this is not universal.
  • Looking for a race-free equation to calculate CVD risk? Check out the new PREVENT score.

  • Our ASCVD Risk Algorithm is a step-wise approach for all adult patients – including those with known ASCVD.
  • This calculator is for use only in adult patients without known ASCVD and LDL 70-189 mg/dL (1.81-4.90 mmol/L).
years

Diabetes

Sex

Smoker

mm Hg

Treatment for hypertension

Race

Race may/may not provide better estimates of CV risk; optional

Result:

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Advice

When Considering Starting Statins

First, always engage in a clinician-patient discussion of the potential for ASCVD risk reduction, adverse effects, drug-drug interactions, and patient preferences. Consider:

  • Potential for ASCVD risk-reduction benefits.
  • Potential for adverse effects and drug-drug interactions.
  • Heart-healthy lifestyle.
  • Management of other risk factors.
  • Patient preferences.

See Section 5 of the relevant 2018 American guidelines for a discussion and recommendations about statin safety. Also see Table 3 of the same guidelines for summary of grossly equivalent statin intensities for different statins at different doses.

When Considering or Using High-Intensity Statins 

The guidelines recommend the treating clinician consider:

  • Multiple or serious comorbidities, such as impaired renal or hepatic function.
  • A history of previous statin intolerance or muscle disorders.
  • Unexplained elevated levels of alanine transaminase greater than three times the upper limit of normal.
  • Patient characteristics or concomitant use of medications that affect statin metabolism.
  • Age older than 75 years.

Remember that the risk of statin-related adverse effects are generally intensity-dependent. 

Additional Factors that are ASCVD Risk Enhancers per 2018 American Guidelines

  • Family history of premature ASCVD.
  • Persistently elevated LDL-C levels at or above 160 mg/dL (4.1 mmol/L).
  • Chronic kidney disease.
  • Metabolic syndrome.
  • Conditions specific to women (e.g. preeclampsia, premature menopause).
  • Inflammatory diseases (especially rheumatoid arthritis, psoriasis, HIV).
  • Ethnicity (e.g. South Asian ethnicity).
  • Persistently elevated triglycerides levels at or above 175 mg/dL (2.0 mmol/L).

  • And in selected individuals if measured:

    • High-sensitivity C-reactive protein (hsCRP) levels at or above 2.0 mg/L.

    • Lp(a) levels above 50 mg/dL (125 nmol/L).

    • ApoB at or above 130 mg/dL.

    • Ankle-brachial index <0.9.

When Monitoring Statin Effects and Side Effects

  • Assess adherence, response to therapy, and adverse effects within 4 to 12 weeks following statin initiation or change in therapy.
  • Measure fasting lipid levels.
  • Do not routinely monitor alanine transaminase or creatine kinase levels unless symptomatic.
  • Screen and treat type 2 diabetes according to current practice guidelines; heart-healthy lifestyle habits should be encouraged to prevent progression to diabetes.
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