CVD Risk Estimator +
Welcome to the CVD Risk Estimator Plus
Click the Terms tab at the bottom of the app before using the
CVD Risk Estimator Plus (“the Product”) to read the full
Terms of Service and License Agreement (the “Agreement”) which
governs the use of the Product. The Agreement includes, among
other detailed terms and conditions, certain disclaimers of
warranties by the American College of Cardiology Foundation
(“ACCF”), terms governing the use of AHA’s PREVENT™ calculator,
and requires the user to agree to release ACCF from any and all
liability arising in connection with your use of the Product.
By using the Product, you accept and agree to be bound by all of
the terms and conditions set forth in the Agreement, including
such disclaimers and releases. If you do not accept the terms
and conditions of the Agreement, you may not proceed to use the
Product. The Agreement is subject to change from time to time,
and your continued use of the Product constitutes your acceptance of
and agreement to be bound by any revised terms of the Agreement.
See the
“About”
"About the App"
screen in
this app for a definition of terms and additional
instructions.
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Estimator Mode
Respond to all questions - this calculator should be used for
primary prevention patients (those without CVD) only.
Sex
Age
(years)
HDL-Cholesterol
(mg/dL)
Total Cholesterol
(mg/dL)
Currently Smoking
Systolic Blood Pressure
(mmHg)
BMI
(kg/m²)
Calculate BMI
eGFR
(mL/min/1.73 m²)
Lipid-lowering medication
Anti-hypertensive medication
Diabetes
The following three predictors are optional for further personalization of
risk assessment when
indicated or available:
UACR
(mg/g)
HbA1c
(%)
Zip Code
Select PREVENT
TM
model(s) to calculate*
The Predicting Risk of Cardiovascular Disease EVENTs (PREVENT
TM
) equations estimate
10-year and 30-year risk for total cardiovascular disease (CVD), including atherosclerotic CVD (ASCVD) and heart failure (HF).
ASCVD
Estimated
10-year
risk of
ASCVD
Pending recalculate
~%
Estimated
30-year
risk of
ASCVD
30-year risk estimates only available for individuals 30 to 59 years of age.
Heart Failure
Estimated
10-year
risk of
HF
Estimated
30-year
risk of
HF
30-year risk estimates only available for individuals 30 to 59 years of age.
CVD
Estimated
10-year
risk of
CVD
Estimated
30-year
risk of
CVD
30-year risk estimates only available for individuals 30 to 59 years of age.
This tool is intended to support clinician-patient discussions and patients should discuss
their risk estimates
with their clinician.
The PREVENT™ equations were developed by select members of the American Heart Association
Cardiovascular-Kidney-Metabolic Scientific Advisory Group. The risk equations were derived and validated in a
large, diverse sample of over 6 million individuals.[1],[2]
[1] Khan SS, Matsushita K, Sang Y, et al. Development and Validation of the American Heart Association Predicting
Risk of Cardiovascular Disease EVENTs (PREVENT™) Equations. Circulation 2023. DOI:
10.1161/CIRCULATIONAHA.123.067626.
[2] Khan SS, Coresh J, Pencina MJ, et al. Novel Prediction Equations for Absolute Risk Assessment of Total
Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the
American Heart Association. Circulation 2023;148(24):1982-2004. DOI: 10.1161/CIR.0000000000001191.
The information derived from the use of PREVENT™ is based on PREVENT™ 1.0.0. Updates and future adaptations of
PREVENT™ may yield different results and conclusions.
The American College of Cardiology Foundation is an independent entity and is not affiliated with, endorsed by,
sponsored by, or approved by American Heart Association (“AHA”). Use of the PREVENT™ risk model and related
materials is pursuant to a license from AHA and does not imply any partnership or association.
Respond to all questions - this calculator should be used for
primary prevention patients (those without ASCVD) only.
10-year ASCVD Risk magnitude calculated using the pooled cohort equation and is no longer supported by ACC
clinical policy or guidelines.
Please review the current 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia for
information on the PREVENT model, available in this tool.
Age
(years)
Sex
Race
Note:
These estimates may
underestimate
the 10-year and lifetime risk for persons
from some race/ethnic groups, especially American Indians, some
Asian Americans (e.g., of south Asian ancestry), and some
Hispanics (e.g., Puerto Ricans), and may
overestimate
the
risk for others, including some Asian Americans (e.g., of east
Asian ancestry) and some Hispanics (e.g., Mexican Americans).
Because the primary use of these risk estimates is to facilitate
the very important discussion regarding risk reduction through
lifestyle change, the imprecision introduced is small enough to
justify proceeding with lifestyle change counseling informed by
these results.
Systolic Blood Pressure
(mmHg)
Diastolic Blood Pressure
(mmHg)
Unit of Measure
Unit of Measure
US
SI
Total Cholesterol
(mg/dL)
(mmol/L)
HDL Cholesterol
(mg/dL)
(mmol/L)
History of Diabetes
Smoker
How long ago did patient quit smoking?
Anti-hypertensive medication
ASCVD (Pooled Cohort Equations)*
Estimated
10-year
risk of ASCVD
~%
Estimated
Optimal 10-year
risk of ASCVD
~%
Estimated
Lifetime
risk of ASCVD
~%
*Disclaimer: The results and recommendations provided by this application are intended to inform
but do not replace clinical judgment. Therapeutic options should be individualized and determined
after discussion between the patient and their care provider.
Values at Previous Visit
Reset
Reset
Age at Previous Visit
Age is
Missing
Age must be between 40-79
Total Cholesterol at Previous Visit
(mg/dL)
(mmol/L)
Total
Cholesterol is Missing
Value must be between 130 - 320
Value must be between 3.367 - 8.288
HDL Cholesterol at Previous Visit
(mg/dL)
(mmol/L)
Value must be between 20 - 100
Value must be between 0.518 - 2.59
LDL Cholesterol at Previous Visit
(mg/dL)
(mmol/L)
LDL Cholesterol
at
Initial Visit is Missing
Value must be between 30-300
Value must be between 0.777-7.770
Systolic Blood Pressure at Previous Visit
(mm Hg)
Systolic
Blood Pressure is Missing
Value must be between 90-200
On Hypertension Treatment at Previous Visit?
Treatment
Hypertension is Missing
History of Diabetes at Previous Visit?
Was a
Smoker
at Previous Visit (or within a year
before the visit)?
Calculate Body Mass Index
Unit of Measure
US
SI
Weight
Height
Project Risk Reduction by Therapy
Reset
View Advice Summary for this
Patient
Continue usual care at MD’s discretion.
LDL-C:
Diabetes:
Smoking:
Aspirin:
Lifestyle:
The most important way
to prevent ASCVD is to promote a healthy lifestyle
throughout life. Medications to reduce ASCVD risk should
only be considered part of a shared decision-making process
for optimal treatment when a patient's risk is sufficiently
high. Decisions around the therapies listed above are
assumed to be made in the context of ACC/AHA
guideline-recommended lifestyle interventions.
Projected 10-Year ASCVD Risk
T1
15.3 %
Stop Smoking, Add Statin Treatments
Add New Treatment Scenario
Remove this
scenario
*Guidelines do
not recommend statin therapy for patients
with 10-year risk < 5%
*Guidelines
do not typically recommend aspirin therapy
for patients with 10-year risk < 10%
*ACC/AHA
Guidelines do not specify antihypertensive drug
therapy for SBP<120 mmHg (<130 mmHg
w/diabetes)
Projected 10-Year ASCVD Risk
T2
15.3 %
Stop Smoking, Add Statin Treatments
Project a
Different Therapy Combination
Remove this
scenario
*Guidelines do
not recommend statin therapy for patients
with 10-year risk < 5%
*Guidelines
do not typically recommend aspirin therapy
for patients with 10-year risk < 10%
*ACC/AHA
Guidelines do not specify antihypertensive drug
therapy for SBP<120 mmHg (<130 mmHg
w/diabetes)
Projected 10-Year ASCVD Risk
T3
15.3 %
Stop Smoking, Add Statin Treatments
Project a
Different Therapy Combination
Remove this
scenario
*Guidelines do
not recommend statin therapy for patients
with 10-year risk < 5%
*Guidelines
do not typically recommend aspirin therapy
for patients with 10-year risk < 10%
*ACC/AHA
Guidelines do not specify antihypertensive drug
therapy for SBP<120 mmHg (<130 mmHg
w/diabetes)
Therapy(s)
Projected ASCVD Risk for this patient if Therapy Initiated
Statin*
BP drug(s)**
Stop smoking†
Aspirinǂ
Statin + Aspirin
BP drug(s) + Aspirin
Statin + BP drug(s)
Statin + Stop smoking
Stop smoking + Aspirin
BP drug(s) + Stop smoking
Statin + BP drug(s) + Aspirin
BP drug(s) + Stop smoking + Aspirin
Statin + BP drug(s) + Stop smoking
Statin + Stop smoking + Aspirin
Statin + BP drug(s) + Stop smoking + Aspirin
*Start moderate intensity statin, or intensify statin from a
moderate to a high intensity dose.
**Start blood-pressure lowering medication if not currently
taking, or add BP-lowering med (s) to patient’s existing
regime.
†Stop smoking for two years
ǂStart or continue taking aspirin.
¶ NA = Not Applicable. Risk is not shown for therapy(s) that are
not recommended. Guidelines do not recommend statin therapy for
patients with 10-year ASCVD risk <5%. Guidelines do not
typically recommend aspirin therapy for patients with 10-year risk
<10%.
View
All Risk Reduction Scenarios
View
All Risk Reduction Scenarios
Estimate
Risk
View Advice
Advice section is accessible when required characteristics for
patients 40-79 years of age are entered.
Estimate
Risk
View Advice
Advice section is accessible when required characteristics for
patients 40-79 years of age are entered.
**
10-year risk for ASCVD is categorized as:
Low-risk
(<5%)
Borderline risk (5% to 7.4%)
Intermediate risk
(7.5% to 19.9%)
High risk (≥20%)
Visit Summary
Treatment Advice
Expand All
LDL-C Management (for this Patient)
Consider whether BP-lowering or LDL-C lowering, or
both, is best approach.
Link to Full ACC/AHA Cholesterol Guideline
Link to Full ACC/AHA CV Risk Guideline
Tobacco Cessation (for this Patient)
Diabetes Mellitus Management (General)
Lifestyle Recommendations (General)
Nutrition and Diet
To reduce ASCVD risk in all patients:
- A diet emphasizing intake of vegetables,
fruits, legumes, nuts, whole grains, and fish
is recommended (I, B-R). A diet containing
reduced amounts of cholesterol and sodium can
be beneficial (IIa, B-NR).
- Replacement of saturated fat with dietary
mono- and poly-unsaturated fats can be
beneficial (IIa, B-NR).
- Minimizing the intake of trans fats,
processed meats, refined carbohydrates, and
sweetened beverages as part of a heart healthy
diet is reasonable (IIa, B-NR).
For adults with type 2 diabetes mellitus:
- A tailored nutrition plan focusing on a
heart-healthy dietary pattern is recommended
to improve glycemic control, achieve weight
loss (if needed), and improve other ASCVD risk
factors (I, A).
Exercise and Physical Activity
To reduce ASCVD risk, adults should:
- Be routinely counseled to optimize a
physically active lifestyle (I, B-R).
- Engage in at least 150 minutes per week of
accumulated moderate intensity or 75 minutes
per week of vigorous intensity aerobic
physical activity (or an equivalent
combination of moderate and vigorous activity)
(I, B-NR). This includes adults with type 2
diabetes mellitus (I, A).
- Decrease sedentary behavior (IIb, C-LD).
For adults unable to meet the minimum physical
activity recommendations:
- Engaging in some moderate or vigorous
intensity physical activity, even if less than
this recommended amount, can be beneficial to
reduce ASCVD risk (IIa, B-NR).
Intensity
METS
Examples
Sedentary Behavior
1-1.5
Sitting, reclining, or lying; watching
TV
Light
1.6-2.9
Walking slowly, cooking, light house
work
Moderate
3.0-5.9
Brisk walking (2.4-4mph), biking
5-9mph, ballroom dancing, active yoga,
recreational swimming
Vigorous
≥6
Jogging/running, biking ≥10mph,
singles tennis, swimming laps
Sedentary behavior is defined as
any waking behavior characterized by an energy
expenditure ≤1.5 metabolic equivalents
(METs), while in a sitting, reclining, or
lying posture. Standing is a sedentary
activity in that it involves ≤1.5 METs, but
is not considered a component of sedentary
behavior; mph indicates miles per hour
Obesity and Being Overweight
In overweight and obese adults:
- Weight loss is recommended to improve the
ASCVD risk-factor profile (I, B-R).
- Counseling and comprehensive lifestyle
interventions, including calorie restriction,
are recommended for achieving and maintaining
weight loss (I, B-R).
- Calculating body mass index is recommended
annually or more frequently to identify
overweight and obese adults for weight loss
considerations (I, C-EO).
- It is reasonable to measure waist
circumference to identify those at higher
cardiometabolic risk (IIa, B-NR).
Aspirin Use Recommendations (for this Patient)
Immunization Practice (General)
CDC's Standards for Adult Immunization Practice
ASSESS
the immunization status of all your
patients at every clinical encounter.
Strongly
RECOMMEND
vaccines that your
patients need.
ADMINISTER
needed vaccines or REFER your
patients to a vaccination provider.
DOCUMENT
vaccines received by your
patients.
Immunization Practice (for this Patient)
Supporting Guideline Recommendation
The pneumococcal vaccine is recommended for patients
65 years of age and older and in high-risk patients
with cardiovascular disease. (1, B).
CDC’s Recommendation for Patients 65 and older
There are three flu vaccines that are preferentially
recommended for people 65 years and older. These are
Fluzone
High-Dose Quadrivalent vaccine
Flublok
Quadrivalent recombinant flu vaccine
and
Fluad Quadrivalent
adjuvanted flu vaccine
. This recommendation was based on a review of
available studies which suggests that, in this age
group, these vaccines are potentially more effective
than standard dose unadjuvanted flu vaccines.
CDC’s Standards for Adult Immunization Practice
ASSESS
the immunization status of all your
patients at every clinical encounter.
Strongly
RECOMMEND
vaccines that your
patients need.
ADMINISTER
needed vaccines or REFER your
patients to a vaccination provider.
DOCUMENT
vaccines received by your
patients.
Therapy Safety Information (General)
See Resource Section of this app for full
prescribing information.
Statins:
There is
moderate quality evidence that statins do not
increase the overall risk of adverse events, but
that they may increase the risk of diagnosis of
type 2 diabetes in certain individuals.
Tobacco Cessation:
Adverse effects of tobacco cessation therapies are
generally poorly reported, and vary by drug.
Aspirin:
There is
high-quality evidence indicating that aspirin may
increase the risk of major bleeding. A calculator
for considering major bleeding risks and potential
benefits of aspirin therapy for MI and stroke
prevention is available
here
10-yr risk for first ASCVD event is:
Actual Risk
Projected Risk
Enter potential treatment scenarios on the "Therapy Impact" tab to
plot them on the graph above as well.
*Projected Risk with the following therapies:
ASA = Start or continue taking aspirin
BP = Start, add, or intensify blood pressure
medication
Ch = Manage cholesterol by starting or intensifying
statin
Sm = Stop smoking for at least 2 years
Inputs
Inputs
Sex:
Female
Race:
White
Values
Previous
Current
Current
Age(years):
Systolic Blood Pressure
(mmHg)
98
140
Diastolic Blood Pressure
(mmHg)
98
140
Total Cholesterol
(mg/dL)
(mmol/L)
240
HDL Cholesterol
(mg/dL)
(mmol/L)
Diabetes:
Smoker:
Treatment for Hypertension:
Yes
Note:
These estimates may
underestimate
the 10-year and lifetime risk for persons
from some race/ethnic groups, especially American Indians, some
Asian Americans (e.g., of south Asian ancestry), and some
Hispanics (e.g., Puerto Ricans), and may
overestimate
the
risk for others, including some Asian Americans (e.g., of east
Asian ancestry) and some Hispanics (e.g., Mexican Americans).
Because the primary use of these risk estimates is to facilitate
the very important discussion regarding risk reduction through
lifestyle change, the imprecision introduced is small enough to
justify proceeding with lifestyle change counseling informed by
these results.
Disclaimer: The results and recommendations provided
by this application are intended to inform but do not replace
clinical judgment. Therapeutic options should be individualized
and determined after discussion between the patient and their care
provider.
Recommendations are designated with both a class of recommendation
(COR) and a level of evidence (LOE). The class of recommendation
indicates the strength of recommendation, encompassing the
estimated magnitude and certainty of benefit in proportion to
risk. The level of evidence rates the quality of scientific
evidence supporting the intervention on the basis of the type,
quantity, and consistency of data from clinical trials and other
sources.
Estimate
Risk
Determine Therapy Impact
Potential risk reduction impact of different therapies can only
be calculated for patients 40-79 years of age at an initial
visit.
Estimate
Risk
Determine Therapy Impact
Potential risk reduction impact of different therapies can only
be calculated for patients 40-79 years of age at an initial
visit.
Resources
Patient Resources
Clinician Resources
References
Clinician Resources
Patient Resources
References
Back to Resources
Clinician Resources
Patient Resources
References
Back to Resources
Understanding My Cardiovascular Risk
The "2013 ACC/AHA Guideline on the Assessment of
Cardiovascular Risk" provides clear recommendations for
estimating cardiovascular disease risk. Risk assessments are
extremely useful when it comes to reducing risk for
cardiovascular disease because they help determine whether a
patient is at high risk for cardiovascular disease, and if so,
what can be done to address any cardiovascular risk factors a
patient may have. Here are the highlights of the guideline:
Risk assessments are used to determine the likelihood of a
patient developing cardiovascular disease, heart attack or
stroke in the future. In general, patients at higher risk
for cardiovascular disease require more intensive
treatment to help prevent the development of
cardiovascular disease.
Risk assessments are calculated using a number of factors
including age, gender, race, cholesterol and blood
pressure levels, diabetes and smoking status, and the use
of blood pressure-lowering medications. Typically, these
factors are used to estimate a patient's risk of
developing cardiovascular disease in the next 10 years.
For example, someone who is young with no risk factors for
cardiovascular disease would have a very low 10-year risk
for developing cardiovascular disease. However, someone
who is older with risk factors like diabetes and high
blood pressure will have a much higher risk of developing
cardiovascular disease in the next 10 years.
If a preventive treatment plan is unclear based on the
calculation of risk outlined above, care providers should
take into account other factors such as family history and
level of C-reactive protein. Taking this additional
information into account should help inform a treatment
plan to reduce a patient's 10-year risk of developing
cardiovascular disease.
Calculating the 10-year risk for cardiovascular disease
using traditional risk factors is recommended every 4-6
years in patients 20-79 years old who are free from
cardiovascular disease. However, conducting a more
detailed 10-year risk assessment every 4-6 years is
reasonable in adults ages 40-79 who are free of
cardiovascular disease. Assessing a patient's 30-year risk
of developing cardiovascular disease can also be useful
for patients 20-59 years of age who are free of
cardiovascular disease and are not at high short-term risk
for cardiovascular disease.
Risk estimations vary drastically by gender and race.
Patients with the same traditional risk factors for
cardiovascular disease such as high blood pressure can
have a different 10-year risk for cardiovascular disease
as a result of their sex and race.
After care providers and patients work together to conduct
a risk assessment, it's important that they discuss the
implications of their findings. Together, patients and
their care providers should weigh the risks and benefits
of various treatments and lifestyle changes to help reduce
the risk of developing cardiovascular disease.
Source:
www.cardiosmart.org
Diet and Physical Activity Recommendations
The "2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk"
provides recommendations for heart-healthy lifestyle choices based on the latest
research and evidence. The guidelines focus on two important lifestyle choices--diet
and physical activity--which can have a drastic impact on cardiovascular health.
Here's what every patient should know about the latest recommendations for reducing
cardiovascular disease risk through diet and exercise.
Diet
Diet is a vital tool for lowering cholesterol and blood
pressure levels, which are two major risk factors for
cardiovascular disease.
Patients with high cholesterol and high blood pressure
levels should eat plenty of vegetables, fruits and whole
grains and incorporate low-fat dairy products, poultry,
fish, legumes, non-tropical vegetable oils and nuts into
their diet. They should also limit intake of sweets,
sugar-sweetened beverages and red meats.
There are many helpful strategies for heart-healthy eating,
including the DASH diet and the USDA's Choose My Plate.
Patients who need to lower their cholesterol should reduce
saturated and trans fat intake. Ideally, only 5-6% of daily
caloric intake should come from saturated fat.
Patients with high blood pressure should consume no more
than 2,400 mg of sodium a day, ideally reducing sodium
intake to 1,500 mg a day. However, even reducing sodium
intake in one's current diet by 1,000 mg each day can help
lower blood pressure.
It's important to adapt the recommendations above, keeping
in mind calorie requirements, as well as, personal and
cultural food preferences. Nutrition therapy for other
conditions like diabetes should also be considered. Doing so
helps create healthy eating patterns that are realistic and
sustainable.
Resources
Heart-Healthy Eating infographic
Knowing Your Salt Intake infographic
Source:
www CardioSmart.org/EatBetter
Physical Activity
Regular physical activity helps lower cholesterol and blood
pressure, reducing the risk for cardiovascular disease.
In general, adults should engage in aerobic physical
activity 3-4 times a week with each session lasting an
average of 40 minutes.
Moderate (brisk walking or jogging) to vigorous (running or
biking) physical activity is recommended to reduce
cholesterol levels.
Resources
6 Ways Regular Physical Activity Benefits Your Heart handout
Move More for Your Heart and Health handout
8 Tips to Move More Every Day handout
Source:
www.CardioSmart.org/MoveMore
Weight Management Recommendations
The "2013 AHA/ACC/TOS Guideline for the Management of
Overweight and Obesity in Adults" was created to reflect the
latest research to outline best practices when it comes to
treating obesity--a condition that affects more than one-third
of American adults. These guidelines help address questions
like "What's the best way to lose weight?" and "When is
bariatric surgery appropriate?". Here is what every patient
should know about the treatment of overweight and obesity:
Definition of obesity:
Obesity is a
medical condition in which excess body fat has accumulated
to the extent that it can have an adverse effect on one's
health. Obesity can be diagnosed using body mass index
(BMI), a measurement of height and weight, as well as
waist circumference. Obesity is categorized as having a
BMI of 30 or greater. Abdominal obesity is defined as
having a waist circumference greater than 40 inches for a
man or 35 inches for a woman.
Benefits of weight loss:
Obesity
increases the risk for serious conditions such as
cardiovascular disease, diabetes and death, but losing
just a little bit of weight can result in significant
health benefits. For an adult who is obese, losing just
3-5% of body weight can improve blood pressure and
cholesterol levels and reduce the risk for cardiovascular
disease and diabetes. Ideally, care providers recommend
5-10% weight loss for obese adults, which can produce even
greater health benefits.
Weight loss strategies:
There is no
single diet or weight loss program that works best for all
patients. In general, reduced caloric intake and a
comprehensive lifestyle intervention involving physical
activity and behavior modification tailored according to a
patient's preferences and health status is most successful
for sustained weight loss. Further, weight loss
interventions should include frequent visits with health
care providers and last more than one year for sustained
weight loss.
Bariatric Surgery:
Bariatric surgery
may be a good option for severely obese patients to reduce
their risk of health complications and improve overall
health. However, bariatric surgery should be reserved for
only the highest risk patients until more evidence is
available on this issue. Present guidelines advise that
weight loss surgery is only recommended for patients with
extreme obesity (BMI ≥40) or in patients that have a
BMI ≥35 in addition to a chronic health condition.
Resources
Weight and Heart Health infographic
How Unhealthy Weight Affects Your Heart handout
Source:
www.CardioSmart.org/Weight
Blood Cholesterol Management Recommendations
Blood Cholesterol Management Recommendations
The American College of Cardiology (ACC) and the American
Heart Association (AHA) recently developed new standards for
treating blood cholesterol. These recommendations are based on
a thorough and careful review of the very latest, highest
quality clinical trial research. They help care providers
deliver the best care possible. This page provides some of the
highlights from the new practice guidelines. The ultimate goal
of the new cholesterol practice guidelines is to reduce a
person's risk of heart attack, stroke and death. For this
reason, the focus is not just on measuring and treating
cholesterol, but identifying whether someone already has or is
at risk for atherosclerotic cardiovascular disease (ASCVD) and
could benefit from treatment.
What is ASCVD?
Heart attack and stroke are usually caused by atherosclerotic
cardiovascular disease (ASCVD). ASCVD develops because of a
build-up of sticky cholesterol-rich plaque. Over time, this
plaque can harden and narrow the arteries.
These practice guidelines outline the most effective
treatments that lower blood cholesterol in those individuals
most likely to benefit. Most importantly, they were selected
as the best strategies to lower cholesterol to help reduce
future heart attack or stroke risk. Share this information
with your health care provider so that you can ask questions
and work together to decide what is right for you.
Key Points
Based on the most up-to-date and complete look at available
clinical trial results:
Health care providers should focus on identifying those
people who are most likely to have a heart attack or
stroke and make sure they are given effective treatment to
reduce their risk.
Cholesterol should be considered along with other factors
known to make a heart attack or stroke more likely.
Knowing your risk of heart attack and stroke can help you
and your health care provider decide whether you may need
to take a medication—most likely a statin—to
lower that risk.
If a medication is needed, statins are recommended as the
first choice to lower heart attack and stroke risk among
certain higher-risk patients based on an overwhelming
amount of evidence. For those unable to take a statin,
there are other cholesterol-lowering drugs; however, there
is less research to support their use.
Evaluating Your Risk
Your health care provider will first want to assess your risk
of ASCVD (assuming you don't already have it). This
information will help determine if you are at high enough risk
of a heart attack or stroke to need treatment.
To do this, your care provider will 1) review your medical
history and 2) gauge your overall risk for heart attack or
stroke. He/she will likely want to know:
whether you have had a heart attack, stroke or blockages
in the arteries of your heart, neck, or legs.
your risk factors. In addition to your total cholesterol,
LDL cholesterol, and HDL (so-called "good") cholesterol,
your health care provider will consider your age, if you
have diabetes, and whether you smoke and/or have high
blood pressure.
about your lifestyle habits, other medical conditions, any
previous drug treatments, and if anyone in your family has
high cholesterol or suffered a heart attack or stroke at
an early age.
A lipid or blood cholesterol panel will be needed as part of
this evaluation. This blood test measures the amount of fatty
substances (called lipids) in your blood. You may have to fast
(not eat for a period of time) before having your blood drawn.
If there is any question about your risk of ASCVD, or whether
you might benefit from drug therapy, your care provider may
make additional assessments or order additional tests. The
results of these tests can help you and your health care team
decide what might be the best treatment for you. These tests
may include:
Lifetime risk estimates
—how
likely you are to have a heart attack and stroke during
your lifetime
Coronary artery calcium (CAC) score
—a test that shows the presence of plaque or fatty
build-up in the heart artery walls
High-sensitivity C-Reactive Protein (CRP)
—a blood test that measures the amount of CRP, a
marker of inflammation or irritation in the body; higher
levels have been associated with heart attack and stroke
Ankle-brachial index (ABI)
—the
ratio of the blood pressure in the ankle compared to blood
pressure in the arm, which can predict peripheral artery
disease (PAD)
If you have very high levels of low-density lipoprotein (LDL
or "bad") cholesterol, your care provider may want to find out
if you have a genetic or familial form of
hypercholesterolemia. This condition can be passed on in
families.
Your Treatment Plan
Before coming up with a specific treatment plan, your care
provider will talk with you about options for lowering your
blood cholesterol and reducing your personal risk of
atherosclerotic disease. This will likely include a discussion
about heart-healthy living and whether you might benefit from
a cholesterol-lowering medication.
Heart-Healthy Lifestyle
Adopting a heart-healthy lifestyle continues to be the first
and best way to lower your risk of problems. Doing so can also
help control or prevent other risk factors (for example: high
blood pressure or diabetes). Experts suggest:
Eating a diet rich in vegetables, fruits, and whole
grains
; this also includes low-fat dairy products, poultry,
fish, legumes, and nuts; it limits intake of sweets,
sugar-sweetened beverages and red meats.
Getting regular exercise
; check with
your health care provider about how often and how much is
right for you.
Maintaining a healthy weight
Not smoking or getting help quitting
Staying on top of your health
, risk
factors and medical appointments. For some people,
lifestyle changes alone may not be enough to prevent a
heart attack or stroke. In these cases, taking a statin at
the right dose will most likely be necessary.
Medications
There are two types of cholesterol-lowering medications:
statins and non-statins.
Statin Therapy
There is a large body of evidence that shows the use of a
statin provides the greatest benefit and fewest safety issues.
In particular, specific groups of patients appear to benefit
most from taking moderate or high-intensity statin therapy.
Based on this information, your care provider will likely
recommend a statin if you have:
ASCVD
Very high LDL cholesterol (190 mg/dL or higher)
Type 2 diabetes and are between 40 and 75 years of age
Above a certain likelihood of having a heart attack or
stroke in the next 10 years (7.5% or higher) and are
between 40 and 75 years of age
In certain cases, your care provider may still recommend a
statin even if you don't fit into one of the groups above.
He/she will consider your overall health and other factors to
help decide if you are at enough risk to benefit from a
statin. Based on the guidelines, these may include:
Family history of premature heart attack or stroke
Your lifetime risk of ASCVD
LDL-cholesterol ≥160 mg/dL
hs-CRP ≥2 mg/L
Results from other special testing (CAC scoring, ABI)
If you are on a statin, your care provider will need to find
the dose that is right for you.
People who have had a heart attack, stroke or other types
of ASCVD tend to benefit the most from taking the highest
amount (dose) of statin therapy if they tolerate it. This
may be more appropriate than taking multiple drugs to
lower cholesterol.
A more moderate dose of statin may be appropriate for some
people with ASCVD, such as those over 75 years or those
that might have problems taking the highest dose of a
statin (i.e., those with prior organ transplantation).
Sometimes more than one statin needs to be tried before
finding the one that works best.
If you are 75 years or older and have not already had a heart
attack, stroke or other types of ASCVD, your care provider
will discuss whether a statin is right for you.
Other cholesterol-lowering medications
Not all patients will be able to take the optimum dose of
statin. After attention to lifestyle changes and statin
therapy, non-statin drugs may be considered if you have
high-risk with known ASCVD, diabetes, or very high LDL
cholesterol values (≥190 mg/dL) and:
Have side effects from statins that prevent you from
getting to the optimal dose or are not able to take a
statin at all.
Are limited from taking an optimal dose due to other drugs
that you are taking, including:
Transplant drug regimens to prevent rejection
Multiple drugs to treat HIV
Some antibiotics like erythromycin and clarithromycin
or certain oral anti-fungal drugs
As always, it's important to talk with your health care
provider about which medication is right for you.
What About Having Goals of Treatment?
Although keeping LDL-cholesterol lower with an optimal dose of
statin is supported strongly by clinical trials, getting to a
specific goal level is not.
Staying on Top of Your Risk
Take steps to lower your risk factors for heart attack,
stroke and other problems
—Make healthy choices (eating a healthy diet,
getting exercise, maintaining a healthy weight and not
smoking). Drug therapy, if needed, can help control risk
factors.
Report side effects
—Muscle aches
are commonly reported and may or may not be due to the
statin. If you are having problems, your care provider
needs to know to help manage any side effects and possibly
switch you to a different statin.
Take your medications as directed
Get blood cholesterol and other tests
that are recommended by your health care team. These can
help assess whether statin therapy—and the
dose—is working for you.
Questions to Ask
What are my risk factors for heart attack and stroke? Am I
on the best prevention program to minimize this risk?
Is my cholesterol high enough that it might be due to a
genetic condition?
What lifestyle changes can I make to stay healthy and
prevent problems?
Do I need to be on a statin?
How do I monitor how I am doing?
What should I do if I develop muscle aches or weakness
after starting the statin?
What do I do if I have other symptoms after starting the
statin?
Resources
Understanding Blood Lipids infographic
LDL Cholesterol and Your Heart infographic
Source:
Groups that Benefit from Statin Therapy Infographic
Common Cardiovascular Terms
Alphabetical Glossary
For additional cardiovascular terms visit
www.cardiosmart.org
More Resource Links
CVD Risk Estimator Plus Terms of Service and License Agreement
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PREVENT™ TERMS AND CONDITIONS
Disclaimer:
The information derived from the use of PREVENT™ is based on
PREVENT™ 1.0.0. Updates and future adaptations of PREVENT™ may yield different results and conclusions.
Attribution Statement:
The PREVENT™ equations were developed by select members of the American Heart
Association Cardiovascular-Kidney-Metabolic Scientific Advisory Group. The risk equations were derived and validated
in a large, diverse sample of over 6 million individuals.[1], [2]
[1] Khan SS, Matsushita K, Sang Y, et al. Development and Validation of the American Heart Association Predicting
Risk of Cardiovascular Disease EVENTs (PREVENT™) Equations. Circulation 2023. DOI:
10.1161/CIRCULATIONAHA.123.067626(link opens in new window).
[2] Khan SS, Coresh J, Pencina MJ, et al. Novel Prediction Equations for Absolute Risk Assessment of Total
Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the
American
Heart Association. Circulation 2023;148(24):1982-2004. DOI: 10.1161/CIR.0000000000001191(link opens in new window).
Non-Affiliation Statement:
The ACCF is an independent entity and is not affiliated with, endorsed
by, sponsored by, or approved by American Heart Association (“AHA”). Use of the PREVENT™ risk model and related
materials is pursuant to a license from AHA and does not imply any partnership or association between AHA and ACCF.
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About the App
This app was last updated:
Mar 2026
Provide feedback:
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feedback survey
Target patient population:
The CVD Risk Estimator Plus is intended for use in patients at risk for cardiovascular
disease (CVD) and CVD-related events, especially due to dyslipidemia and hypertension.
The PREVENT™ estimator mode is intended for adult patients without CVD aged 30-79 years
for 10-year risk, and aged 30-59 years for 30-year risk. The Pooled Cohort estimator mode
is intended for adult patients without ASCVD aged 40-79 years for 10-year risk, and 20-59
years for lifetime risk.
About the CVD Risk Estimator Plus
CVD Risk Estimator Plus is a clinical decision support app that
unifies two cardiovascular prevention tools: the 2013 ACC/AHA
Pooled Cohort Equations (previously known as the ASCVD Risk
Estimator) and the American Heart Association’s PREVENT™
Calculator. Combining traditional ASCVD risk modeling with modern
cardiovascular kidney metabolic (CKM)-inclusive risk equations,
CVD Risk Estimator Plus provides clinicians with a comprehensive,
personalized cardiovascular disease (CVD) risk assessment.
Core Functionality: Dual Engine Risk Modeling
CVD Risk Estimator Plus computes risk estimates using:
2013 ASCVD Pooled Cohort Equations (PCE), which calculate
10-year and lifetime risk of atherosclerotic cardiovascular
disease using age, sex, race, blood pressure, cholesterol
profile, diabetes status, and smoking status.
2023 PREVENT™ Equations, which estimate 10- and 30-year risk
for total CVD, ASCVD, and heart failure (HF), incorporating
kidney and metabolic health measures such as BMI and estimated
glomerular filtration rate (eGFR), and supporting optional
predictors including urine albumin creatinine ratio (UACR),
hemoglobin A1c (HbA1c), and social deprivation index (SDI).
Clinicians can toggle between PCE and PREVENT™ risk trajectories,
for reference and comparison.
Decision Support & Shared Decision Tools
To support guideline-aligned prevention conversations, CVD Risk
Estimator Plus provides:
Risk category classification (low, borderline, intermediate, high)
Export functionality supporting print and email of results for
documentation and patient communication.
Resources page with related tools and informational resources
for both clinicians and patients, as well as links to
reference documents.
Why This Combined Tool Matters
By merging the long-established ASCVD Risk Estimator with the
cutting-edge PREVENT™ equations, CVD Risk Estimator Plus reflects
the evolution of cardiovascular prevention science.
How was this App developed?
Predicting Risk of Cardiovascular Disease EVENTs equations (PREVENT™):
The PREVENT™ equations were developed by select members of the
American Heart Association Cardiovascular-Kidney-Metabolic
Scientific Advisory Group. The risk equations were derived and
validated in a large, diverse sample of over 6 million
individuals.
Khan SS, Matsushita K, Sang Y, et al. Development and
Validation of the American Heart Association Predicting Risk of
Cardiovascular Disease EVENTs (PREVENTTM) Equations.
Circulation 2023. DOI: 10.1161/CIRCULATIONAHA.123.067626.
Khan SS, Coresh J, Pencina MJ, et al. Novel Prediction
Equations for Absolute Risk Assessment of Total Cardiovascular
Disease Incorporating Cardiovascular-Kidney-Metabolic Health:
A Scientific Statement From the American Heart Association.
Circulation 2023;148(24):1982-2004. DOI:
10.1161/CIR.0000000000001191.
The information derived from the use of PREVENT™ is based on
PREVENT™ 1.0.0. Updates and future adaptations of PREVENT™ may
yield different results and conclusions.
Pooled Cohort Equations (PCE):
PCE 10-year ASCVD risk is calculated via the Pooled Cohort
Equation published as part of the 2013 ACC/AHA Guideline on the
Assessment of Cardiovascular Risk. The Risk Estimator was
designed and vetted through collaboration with the authors of the
source documents noted below, as well as other ACC clinical
members. It was further refined via user testing with physicians,
nurse practitioners, and pharmacists.
Goff, D, Lloyd-Jones, D, Bennett, G. et al. 2013 ACC/AHA
Guideline on the Assessment of Cardiovascular Risk: A Report of
the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines. JACC. 2014 Jul,
63 (25_Part_B) 2935–2959.
Lloyd-Jones D.M., Leip E.P., Larson M.G., et al. (2006)
Prediction of lifetime risk for cardiovascular disease by risk
factor burden at 50 years of age. Circulation 113:791-798
Disclaimer: The American College of Cardiology Foundation is an
independent entity and is not affiliated with, endorsed by,
sponsored by, or approved by American Heart Association (“AHA”).
Use of the PREVENT™ risk model and related materials is pursuant
to a license from AHA and does not imply any partnership or
association.
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Table 6. Risk-Enhancing Factors for Clinician–Patient Risk
Discussion
Risk-Enhancing Factors
Family history of premature ASCVD
(males, age <55 y;
females, age <65 y)
Primary hypercholesterolemia
(LDL-C, 160–189 mg/dL
[4.1–4.8 mmol/L); non–HDL-C 190–219 mg/dL [4.9–5.6
mmol/L])
Metabolic syndrome
(increased waist circumference,
elevated triglycerides [≥150 mg/dL], elevated blood
pressure, elevated glucose, and low HDL-C [<40 mg/dL in
men; <50 in women mg/dL] are factors; tally of 3 makes the
diagnosis)
Chronic kidney disease
(eGFR 15–59 mL/min/1.73 m
with or without albuminuria; not treated with dialysis or
kidney transplantation)
Chronic inflammatory conditions
such as psoriasis, RA,
or HIV/AIDS
History of premature menopause (before age 40 y) and
history of pregnancy-associated conditions that increase
later ASCVD risk such as preeclampsia
High-risk race/ethnicities
(e.g., South Asian ancestry)
Lipid/biomarkers:
Associated with increased ASCVD risk
Persistently
elevated, primary
hypertriglyceridemia (≥175 mg/dL);
If measured:
Elevated high-sensitivity C-reactive protein
(≥2.0 mg/L)
Elevated Lp(a):
A relative indication for its
measurement is family history of premature ASCVD. An
Lp(a) ≥50 mg/dL or ≥125 nmol/L constitutes a
risk-enhancing factor especially at higher levels of
Lp(a).
Elevated apoB
≥130 mg/dL: A relative indication
for its measurement would be triglyceride ≥200 mg/dL.
A level ≥130 mg/dL corresponds to an LDL-C >160 mg/dL
and constitutes a risk-enhancing factor
ABI
<0.9
Optimally, 3 determinations.
AIDS indicates acquired immunodeficiency syndrome; ABI, ankle-brachial
index; apoB, apolipoprotein B; ASCVD, atherosclerotic cardiovascular
disease; eGFR, estimated glomerular filtration rate; HDL-C, high-density
lipoprotein cholesterol; HIV, human immunodeficiency virus; LDL-C,
low-density lipoprotein cholesterol; Lp(a), lipoprotein (a); and RA,
rheumatoid arthritis.
Table 5. Diabetes-Specific Risk Enhancers Independent of Other Risk
Factors in Diabetes Mellitus
Risk Enhancers
Long duration (≥10 years for type 2 diabetes mellitus or ≥20
years for type 1 diabetes mellitus)
Albuminuria ≥30 mcg of albumin/mg creatinine
eGFR <60 mL/min/1.73 m
Retinopathy
Neuropathy
ABI
<0.9
ABI indicates ankle-brachial index; and eGFR, estimated
glomerular filtration rate.
Heaviness of Smoking Index:
Use to assess degree of nicotine dependence to help guide intensity of
treatment.
How many cigarettes do you smoke?
Answer
Score
10 or fewer
11-20
21-30
≥ 31
How soon after waking up do you smoke your first cigarette of the
day?
Answer
Score
After 60 minutes
31-60 minutes
6-30 minutes
Within 5 minutes
Level of nicotine dependence is computed by adding the scores
together
Score
Level of Nicotine Dependence
0-2
Low
3-4
Moderate
5-6
High
US