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. See the Quality Rating rationale for more information. 

  • Learn more about our approach to addressing race and bias on MDCalc.
  • Looking for a race-free equation to calculate CVD risk? Check out the PREVENT score.

As of 2026, the ACC/AHA dyslipidemia guidelines recommends using PREVENT over this tool for primary prevention risk assessment because of improved accuracy, more contemporary derivation cohorts, and elimination of race-based estimation. PREVENT provides risk estimates approximately 40%–50% lower than the 2013 ASCVD Risk Score for the same risk factor profile, with correspondingly adjusted treatment thresholds (≥3% for PREVENT vs ≥5% for the 2013 ASCVD Risk 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

Result:

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Advice

Interpret results of this tool within the clinical context, and consider the following during the clinician-patient discussion:

  • Absolute risk estimate.
  • Net benefit of therapy.
  • Socioeconomic status.
  • Patient preferences and values.
  • Risk-enhancing factors, including:
    • Family history of premature ASCVD.
    • Persistently elevated LDL-C ≥160 mg/dL.
    • Metabolic syndrome.
    • Chronic kidney disease.
    • History of preeclampsia or premature menopause (age <40 years).
    • Chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, HIV).
    • High-risk ethnicity (e.g., South Asian ancestry).
    • Persistent triglyceride elevation ≥175 mg/dL.
  • Supporting studies, when available: 
    • Apolipoprotein B ≥130 mg/dL.
    • hs-CRP ≥2.0 mg/L.
    • Ankle-brachial index (ABI) <0.9.
    • Lipoprotein(a) ≥50 mg/dL.
Management

Treatment thresholds based on this tool are historical, as ACC/AHA dyslipidemia guidelines now recommend PREVENT for primary prevention risk assessment; if this tool is used, the following management thresholds might be considered:

  • 10-year ASCVD risk ≥7.5%: Consider initiating moderate- or high-intensity statin therapy after clinician-patient discussion.
    • If 10-year risk ≥20%: Consider high-intensity statin to reduce LDL-C ≥50%.
    • If 10-year risk 7.5%–19.9%: Consider moderate-intensity statin to reduce LDL-C ≥30%.
  • 10-year ASCVD risk 5% to <7.5%:
    • Evaluate risk-enhancing factors.
    • Consider statin therapy if risk enhancers present.
    • May use coronary artery calcium (CAC) scoring to refine the treatment decision.
  • 10-year ASCVD risk <5%:
    • Emphasize lifestyle modification.
    • Reassess risk factors every 4–6 years.
  • For stage 1 hypertension (130–139/80–89 mm Hg): Categorize as <10% or ≥10% 10-year ASCVD risk for therapeutic decisions, and refer to most recent AHA/ACC guidelines.
  • Follow-up:
    • Reassess lipids 4–12 weeks after statin initiation or dose adjustment.
    • Repeat every 3–12 months as needed.
    • Assess adherence and percentage LDL-C reduction from baseline.
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