ASCVD Risk Estimator Plus
A comprehensive clinical tool based on the 2018/2019 ACC/AHA Multisociety Guidelines. Estimate current 10-year ASCVD risk, compare it to optimal risk, and review tailored statin, aspirin, and blood pressure therapy advice.
1. Patient Demographics
2. Labs & Vitals
3. Medical History & Therapy
Enter comprehensive patient data to calculate Current Risk vs. Optimal Risk and view guideline-based therapy advice.
Clinical Parameters & Conversions Applied
Lipid Panel Conversion: Standardized to mg/dL for Pooled Cohort Equation execution. Select mmol/L to automatically convert by a factor of 38.67.
Age Demographics: The 10-year risk equations are strictly validated for adults aged 40-79. For patients aged 20-39, guidelines recommend focusing on lifetime risk estimates and major risk enhancer management.
The ASCVD Risk Estimator Plus: What Changed?
The ASCVD Risk Estimator Plus is an evolution of the original 2013 calculator, updated to reflect the critical shifts in the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol and the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease.
The “Plus” model introduces the concept of Optimal Risk, providing clinicians with a powerful motivational tool. It illustrates to the patient exactly how much their 10-year risk could decrease if their modifiable risk factors (blood pressure, cholesterol, smoking) were managed to optimal baseline levels.
Advanced Therapy Logic (2018/2019 Guidelines)
The modern calculator doesn’t just output a number; it dictates treatment pathways based on specific clinical triggers:
- Extreme LDL Elevations: Any patient with an LDL-C ≥ 190 mg/dL is automatically recommended for high-intensity statin therapy, bypassing the need for a 10-year risk score entirely.
- Diabetic Patients (Age 40-75): Automatically placed into a moderate-to-high intensity statin bracket. The 10-year score is still calculated to determine if they should be upgraded from moderate to high intensity (e.g., if risk ≥ 20% or multiple risk factors exist).
- Aspirin Use Update: The 2019 guidelines drastically pulled back on routine Aspirin use for primary prevention. It is now rarely recommended due to bleeding risks, reserved only for select high-risk patients aged 40-70 who are not at an increased risk of bleeding.
Decoding the Risk Categories (Ages 40-79)
| Risk Tier | 10-Year Percentage | Guideline Recommendation |
|---|---|---|
| Low Risk | < 5.0% | Emphasize lifestyle modifications. Statins are not generally indicated. |
| Borderline Risk | 5.0% to < 7.5% | Discuss risk enhancers. Consider moderate-intensity statin if enhancers exist. |
| Intermediate Risk | 7.5% to < 20.0% | Moderate-intensity statin favored. Utilize Coronary Artery Calcium (CAC) scoring if decision is uncertain. |
| High Risk | ≥ 20.0% | High-intensity statin strongly recommended to reduce LDL-C by ≥ 50%. |
Handling “Other” Races in the Algorithm
A known limitation of the Pooled Cohort Equations is the strict division into White and African American cohorts. For populations such as Hispanic, Asian, or Native American, the AHA/ACC guidelines instruct clinicians to utilize the White equation. However, practitioners must apply clinical judgment, recognizing that the score may underestimate risk in certain populations (e.g., South Asians) and overestimate it in others (e.g., East Asians).
