About the Application
When was this app last updated?
August 2023
How can I provide feedback?
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How is this app intended to be used?
This Risk Estimator is intended as a companion tool to
the 2013 ACC/AHA Guideline on
the Assessment of
Cardiovascular Risk and the 2018 AHA/ACC Guideline
on the Management of Blood Cholesterol. This Risk Estimator 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 lifetime risk prediction tools.
The Risk Estimator is intended for use in those without
ASCVD with a LDL-cholesterol <190 mg/dL.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.
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.
How are the estimates in this app calculated?
10-Year ASCVD Risk Estimates
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 under-
or overestimate risk for persons from some race/ethnic
groups.
Lifetime ASCVD Risk Estimates
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 Estimator.
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
over-estimates 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.
10-Year Risk Estimates that Exceed Lifetime Risk Estimates
In rare cases, 10-year risks may exceed lifetime risks
given that the estimates come from different approaches.
The reported estimate of lifetime risk is based on
assigning each person into one of 5 mutually exclusive
sex-specific groups, as per Lloyd-Jones et al.,
Circulation 2006; 113(6):791-8. Within each of the 5
groups, each person receives the same lifetime risk
estimate. In other words, using this approach, there are
only 5 possible lifetime risk estimates reported for men
and only 5 possible lifetime risk estimates reported for
women. In some cases, the average risk for the group will
underestimate the individual’s true lifetime risk.
This feature of lifetime risk estimation will result in
the estimated lifetime risk being less than the estimated
10-year risk. In these cases, the 10-year risk should be
the primary focus for the risk discussion and risk
reduction efforts.
Application Credits
2013 ACC/AHA Guideline on the Assessment of Cardiovascular
Risk
David C. Goff, MD, PhD, FACP, FAHA
• Donald M. Lloyd-Jones, MD, ScM,
FACC, FAHA
• Glen Bennett, MPH
• Christopher J. O'Donnell, MD,
MPH
• Sean Coady, MS
• Jennifer Robinson, MD, MPH,
FAHA
• Ralph B. D'Agostino,Sr, PhD,
FAHA
• J. Sanford Schwartz, MD
• Raymond Gibbons, MD, FACC,
FAHA
• Susan T. Shero, MS, RN
• Philip Greenland, MD, FACC,
FAHA
• Sidney C. Smith, MD, FACC,
FAHA
• Daniel T. Lackland, DrPH,
FAHA
• Paul Sorlie, PhD
• Daniel Levy, MD
• Neil J. Stone, MD, FACC,
FAHA
• Peter W.F. Wilson, MD,
FAHA
2013 ACC/AHA Guideline on the Treatment of Blood
Cholesterol to Reduce Atherosclerotic Cardiovascular Risk
in Adults
Neil J. Stone, MD, MACP, FAHA, FACC
• Jennifer Robinson, MD, MPH,
FAHA
• Alice H. Lichtenstein, DSc,
FAHA
• C. Noel Bairey Merz, MD, FAHA,
FACC
• Donald M. Lloyd-Jones, MD, ScM,
FACC, FAHA
• Conrad B. Blum, MD, FAHA
• Patrick McBride, MD, MPH,
FAHA
• Robert H. Eckel, MD, FAHA
• J. Sanford Schwartz, MD
• Anne C. Goldberg, MD, FACP,
FAHA
• Susan T. Shero, MS, RN
• David Gordon, MD
• Sidney C. Smith
• Daniel Levy, MD
• Karol Watson, MD, PhD, FACC,
FAHA
• Peter W.F. Wilson, MD,
FAHA
2013 AHA/ACC/TOS Guideline for the Management of
Overweight and Obesity in Adults
Michael D. Jensen, MD
• Donna H. Ryan, MD
• Caroline M. Apovian, MD,
FACP
• Catherine M. Loria, PhD,
FAHA
• Jamy D. Ard, MD
• Barbara E. Millen, DrPH,
RD
• Anthony G. Comuzzie, PhD
• Cathy A. Nonas, MS, RD
• Karen A. Donato, SM
• F. Xavier Pi-Sunyer, MD,
MPH
• Frank B. Hu, MD, PhD,
FAHA
• June Stevens, PhD
• Van S. Hubbard, MD, PhD
• Victor J. Stevens, PhD
• John M. Jakicic, PhD
• Thomas A. Wadden, PhD
• Robert F. Kushner, MD
• Bruce M. Wolfe, MD
• Susan Z. Yanovski, MD
2013 AHA/ACC Guideline on Lifestyle Management to Reduce
Cardiovascular Risk
Robert H. Eckel, MD, FAHA
• John M. Jakicic, PhD
• Jamy D. Ard, MD
• Nancy Houston
• Miller, RN, BSN, FAHA
• Van S. Hubbard, MD, PhD
• Cathy A. Nonas, MS, RD
• Janet M. de Jesus, MS, RD
• Frank M. Sacks, MD, FAHA
• I-Min Lee, MD, ScD
• Sidney C. Smith
• Alice H. Lichtenstein, DSc,
FAHA
• Laura P. Svetkey, MD, MHS
• Catherine M. Loria, PhD,
FAHA
• Thomas W. Wadden, PhD
• Barbara E. Millen, DrPH, RD,
FADA
• Susan Z. Yanovski, MD
2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood
Cholesterol
Scott M. Grundy
• Neil J. Stone
• Alison L. Bailey
• Craig Beam
• Kim K. Birtcher
• Roger S. Blumenthal
• Lynne T. Braun
• Sarah de Ferranti
• Joseph Faiella-Tommasino
• Daniel E. Forman
• Ronald Goldberg
• Paul A. Heidenreich
• Mark A. Hlatky
• Daniel W. Jones
• Donald Lloyd-Jones
• Nuria Lopez-Pajares
• Chiadi E. Ndumele
• Carl E. Orringer
• Carmen A. Peralta
• Joseph J. Saseen
• Sidney C. Smith Jr
• Laurence Sperling
• Salim S. Virani
• Joseph Yeboah
Application Development Credits
Concepts for this application adapted from the Cardiac
Risk Assist App developed by Tin T.D. Nguyen, MD.
Special Thanks to the ACC Best Practice Quality
Improvement Subcommittee, whose members have provided
content development and review