Lipid Lens

Understand Your Risk

Four cornerstones of modern cardiovascular risk assessment, with patient-friendly and clinician-oriented detail throughout.

A · ASCVD risk estimator

PREVENT Score

An updated risk calculator (AHA, 2023) that estimates 10-year — and optionally 30-year — risk of an atherosclerotic cardiovascular disease event.

The PREVENT score combines your age, blood pressure, cholesterol, kidney function, diabetes status, and other factors to estimate your chance of having a heart attack or stroke in the next 10 years.

10-yr RiskTierTreatment Guidance
< 3%Low riskLifestyle focus — diet, activity, weight, tobacco cessation.
3% to < 5%BorderlineReasonable to consider starting lipid-lowering medication.
5 – 10%IntermediateLipid-lowering medication recommended.
> 10%High riskMedication strongly recommended; intensify lifestyle measures.

The treatment guidance above applies to primary prevention — people with no prior history of ASCVD (heart attack, stroke, or other established cardiovascular disease). If you have established ASCVD, your physician will use more intensive targets. This is patient education; actual decisions should involve shared decision-making with your physician.

Open the MDCALC PREVENT Score calculator
B · Treat-to-target

LDL Cholesterol Goals by Risk Category

LDL targets descend as cardiovascular risk rises — the higher the risk, the larger the absolute benefit of further LDL reduction.

High risk (established ASCVD / very high risk)
< 55 mg/dL
LDL-C goal

Recurrent-event risk is highest — deeper LDL reduction yields larger absolute benefit.

ASCVD, not very high risk
< 70 mg/dL
LDL-C goal

Established disease still warrants aggressive secondary prevention.

Intermediate primary-prevention risk
< 100 mg/dL
LDL-C goal

Lower baseline event rate; goals balance benefit against medication burden.

C · Body composition

Waist-to-Hip Ratio

Central adiposity tracks more closely with cardiovascular and metabolic risk than weight or BMI alone.

How to measure

Waist-to-hip ratio measurement illustration showing waist and hip measurement locations

Illustration style reference: Google Image Search

  • Waist: narrowest point, above the hip bones and below the ribs. Exhale gently; don't suck in.
  • Hips: widest point around the buttocks. Keep the tape level all the way around.

Calculator

Enter measurements in the same unit (cm or in).

Your waist-to-hip ratio
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Threshold for men: ratio > 0.9 indicates increased cardiovascular risk.

Men
> 0.90 = increased CV risk
Women
> 0.85 = increased CV risk
D · Imaging biomarker

Coronary Artery Calcium (CAC) Score

A low-dose CT scan that quantifies calcified plaque in the coronary arteries, reported as an Agatston score.

In plain language
A CAC scan is a quick, no-contrast CT that looks for tiny calcium deposits in the arteries of your heart. More calcium generally means more underlying plaque — and a higher chance of a future heart event.
Clinical detail
CAC is the strongest single non-invasive marker of subclinical coronary atherosclerosis and meaningfully reclassifies risk in borderline-to-intermediate PREVENT/PCE patients. A score of 0 supports deferring statin therapy in most; ≥100 (or ≥75th percentile for age/sex) supports initiation or intensification.

Who should consider it?

  • Men > 40 with borderline or intermediate 10-year ASCVD risk
  • Women > 45 with borderline or intermediate 10-year ASCVD risk
  • Patients undecided about starting a statin after shared decision-making

How the score informs therapy

  • CAC = 0Statin can usually be deferred (re-assess in 5–10 yr)
  • CAC 1–99Favors statin, especially if ≥ 55 yr
  • CAC ≥ 100Initiate or intensify statin therapy