The American Heart Association and the American College of Cardiology are excited to provide a series of new cardiovascular prevention guidelines for the assessment of cardiovascular risk, lifestyle modifications that reduce risk, management of elevated blood cholesterol, and management of increased body weight in adults. To support the implementation of these guidelines, the new Pooled Cohort Equations CV Risk Calculator and additional Prevention Guideline Tools are available below. Others may be developed and available in the near future.
This downloadable spreadsheet is a companion tool to the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. The spreadsheet enables health care providers and patients to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD), defined as coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke, based on the Pooled Cohort Equations and the work of Lloyd-Jones, et al., respectively. The information required to estimate ASCVD risk includes age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status.
Estimates of 10-year risk for ASCVD are based on data from multiple community-based populations and are applicable to African-American and non-Hispanic white men and women 40 through 79 years of age. For other ethnic groups, we recommend use of the equations for non-Hispanic whites, though these estimates may underestimate the 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).
Estimates of lifetime risk for ASCVD are provided for adults 20 through 59 years of age and are shown as the lifetime risk for ASCVD for a 50-year old without ASCVD who has the risk factor values entered into the spreadsheet. The estimates of lifetime risk are most directly applicable to non-Hispanic whites. We recommend the use of these values for other race/ethnic groups, though as mentioned above, these estimates may represent under- and overestimates for persons of various ethnic groups. Because the primary use of these lifetime 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.
The figure to the right represents the recommendations of the Risk Assessment Work Group. Further details regarding the derivation and validation, and strategies for implementation, of the risk assessment algorithm are available in the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk and the Full Report of the Risk Assessment Work Group. These reports also contain the information necessary for programming the risk assessment algorithm into an electronic health record to allow for automatic calculation of 10-year and lifetime risk estimates in clinical practice settings.
Figure 1. Implementation of Risk Assessment Work Group Recommendations
ACC indicates American College of Cardiology; AHA, American Heart Association; and ASCVD, atherosclerotic cardiovascular disease