CV Risk Calculator
SCORE2 · QRISK3 · PREVENT-ASCVD · CAC · CAD-RADS

ESC/EAS 2019 · NICE NG238 · 2026 ACC/AHA Dyslipidemia Guideline
SCORE2 UK (low CVD-risk region) · PREVENT-ASCVD (US)
Clinician Tool CVRisk1–7 with CT sub-criteria · v1.2 · May 2026
Targets shown in mmol/L (SI) & mg/dL (US)

Global guideline consensus — three frameworks, one principle

This calculator integrates three international frameworks. ESC SCORE2 / SCORE2-OP (Europe), QRISK3 (UK / NICE NG238), and PREVENT-ASCVD (US / 2026 ACC/AHA Multisociety Dyslipidemia Guideline — Blumenthal et al., JACC 2026) all rank-order patients similarly and converge on the same lipid targets at each risk level. Where calculators disagree (e.g. SCORE2 low but CAC above the 75th centile), imaging-defined disease takes precedence. The 2026 ACC/AHA guideline explicitly elevates CAC scoring to a primary decision-modifier with CAC-specific LDL goals (CAC ≥100 / ≥75th centile → LDL <70 mg/dL; CAC 300–999 → <55 mg/dL) — paralleling the Clinician Tool CT-augmented tier philosophy. All lipid targets displayed in dual units: mmol/L (SI / UK / Europe) with mg/dL (US) equivalents.

ESC / EAS 2019

SCORE2 + risk-stratified targets

Age-banded SCORE2 thresholds → Low / Moderate / High / Very-high tiers. Each tier has formal LDL-C, non-HDL-C and ApoB target. "Lower is better" endorsed.

NICE NG238 (UK)

QRISK3 + % reduction goal

QRISK3 ≥10% triggers atorvastatin 20 mg primary prevention. Goal: >40% non-HDL reduction. Secondary prevention: LDL-C ≤2.0 mmol/L (≤77 mg/dL).

AHA / ACC / MS 2025

PREVENT-ASCVD + numeric goals

2026 ACC/AHA Multisociety Dyslipidemia Guideline. Four risk groups: Low <3% · Borderline 3–<5% · Intermediate 5–<10% · High ≥10%. Numeric LDL goals: borderline/intermediate <100 mg/dL (2.6 mmol/L); high (≥10%) <70 mg/dL (1.8 mmol/L). VHR ASCVD: <55 mg/dL (1.4 mmol/L).

⚠ Use pre-treatment values only

SCORE2 / QRISK3 / PREVENT-ASCVD are primary-prevention risk calculators validated against the patient's baseline (pre-treatment) lipid profile. They are not validated for patients already on statins, ezetimibe, PCSK9 inhibitors, bempedoic acid, or other lipid-lowering therapy.

For patients not yet on lipid-lowering therapy: enter the current non-HDL-C — this is the pre-treatment value.
For patients already on lipid-lowering therapy: use the most recent untreated lipid result (often the earliest blood test in the record, before initiation). If no pre-treatment value exists, interpret the result with caution — the "real" untreated risk is higher than the score will show.
For patients with established ASCVD or imaging-defined disease, use the secondary-prevention overrides — the calculated SCORE2 is irrelevant.

Non-HDL calculator — TC − HDL

Optional helper if you only have TC and HDL. Enter either fasting or non-fasting values (non-HDL is robust to feeding state, unlike calculated LDL). Units are auto-detected from typical clinical ranges.

Total cholesterol (TC) — enter value

HDL cholesterol — enter value

Enter TC and HDL above to calculate non-HDL — then pick the matching band in the patient variables card below.

Patient variables — SCORE2

<50 yrs <2.5%
50–69 <5%
Low–mod

<50: 2.5–7.5%
50–69: 5–10%
High

<50: ≥7.5%
50–69: ≥10%
Very high

QRISK3 <10%
Low (NICE)

QRISK3 ≥10%
Treat (NICE)

CT high risk
Clinician Tool tier

CT ultra-high
Clinician Tool tier

Sex Age band Smoking status

Systolic BP (mmHg) — current measured value On antihypertensive treatment — add 10 mmHg correction for SCORE2

Pre-treatment non-HDL cholesterol (mmol/L) — mg/dL shown alongside

QRISK3 (UK) & PREVENT-ASCVD (US) — primary prevention scores

QRISK3 is the NICE NG238 recommended primary prevention tool used in UK general practice. Enter the score if available. QRISK3 ≥10% triggers statin treatment per NICE. It does not map directly to ESC risk strata but is used here alongside SCORE2 — whichever gives the higher tier applies.

For US clinicians (2026 ACC/AHA): The 2026 ACC/AHA Multisociety Dyslipidemia Guideline (Blumenthal et al., JACC 2026, doi:10.1016/j.jacc.2025.11.016) formally adopts the PREVENT-ASCVD equations as the primary US risk calculator, replacing PCE for ages 30–79 with LDL-C 70–189 mg/dL (1.8–4.9 mmol/L). PREVENT incorporates eGFR, BMI, HbA1c & social deprivation; race omitted. Race calibration in PCE is no longer used. Risk groups (10-yr ASCVD): Low <3% · Borderline 3–<5% · Intermediate 5–<10% · High ≥10%. Numeric LDL goals: borderline/intermediate <100 mg/dL (2.6 mmol/L); high (≥10%) <70 mg/dL (1.8 mmol/L) + ≥50% ↓; VHR ASCVD <55 mg/dL (1.4 mmol/L). Risk-enhancing factors (Table 13): premature ASCVD family hx (M<55, W<65) · higher-risk ancestry (S Asian, Filipino) · high polygenic risk · chronic inflammatory disease (SLE, RA, advanced psoriasis) · Lp(a) ≥125 nmol/L or ≥50 mg/dL · hs-CRP ≥2 mg/L on >1 occasion · TG ≥175 mg/dL (2 mmol/L) non-fasting or ≥150 mg/dL (1.7) fasting · CKM syndrome · LDL persistently 160–189 mg/dL or ApoB ≥120 mg/dL · reproductive risk markers (premature menopause, preeclampsia, GDM, gestational HTN, preterm delivery). New COR 1: Lp(a) measurement at least once in every adult. New COR 2a: ApoB measurement on LLT especially with ASCVD, CKM, T2D, or elevated TG. CAC decision-modifier: CAC = 0 + no high-risk features → defer LLT, repeat in 3–7 years (COR 2a). CAC 1–99 AU <75th centile → moderate-intensity statin, LDL <100 mg/dL (COR 2a). CAC 100–299 AU or ≥75th centile → LDL <70 mg/dL (COR 1). CAC 300–999 AU → LDL <55 mg/dL (COR 2a).

QRISK3 score (%) — or equivalent 10-yr ASCVD from PREVENT-ASCVD (2026 ACC/AHA)

CAC scoring — Agatston / CAC-DRS & CAD-RADS (if available)

Complete the fields that are available from the radiology report. CAC-DRS and CAD-RADS will auto-assign Clinician Tool CT tiers. Leave fields at default (none/0) if not performed.

Agatston score CAC centile for age/sex

CAC-DRS (AN) — Agatston + vessels CAC-DRS (VN) — Volume + vessels

CAD-RADS grade (CTCA) Plaque burden — P grade (CAD-RADS 2.0)

CAD-RADS modifiers

/HRP — High-risk plaque (CAD-RADS 2.0) /V — Vulnerable plaque (LRNC / spotty Ca²⁺ / PR / NRS) /N — Non-diagnostic segment(s) /S or /G — Prior stent or bypass graft

SCORE2 UK low-CVD-risk region. Non-HDL = Total cholesterol − HDL-C (pre-treatment values; see helper calculator above). Sources: ESC/SCORE2 Working Group, Eur Heart J 2021 · NICE NG238 (2023) · 2026 ACC/AHA Multisociety Dyslipidemia Guideline (Blumenthal RS et al., JACC 2026, doi:10.1016/j.jacc.2025.11.016 · co-published Circulation) · PREVENT equations (Khan SS et al., Circulation 2024). CT tiers are Clinician Tool defined (May 2026 v1.2) based on ESC/EAS 2019 framework, 2026 ACC/AHA CAC-specific LDL goals, CaRi-Heart FAI centile methodology (Antoniades et al., ORFAN/CRISP-CT), and Clinician Tool clinical protocol. SCORE2 applies to primary prevention aged 40–69 without the clinical overrides listed, and is not validated for patients already on lipid-lowering therapy — use pre-treatment lipid values. PREVENT-ASCVD (ACC/AHA preferred US calculator) applies to ages 30–79 with LDL 70–189 mg/dL (1.8–4.9 mmol/L). All three guideline frameworks converge on the same risk-graded targets — the higher the risk, the lower the LDL-C / ApoB goal. Targets shown in dual units (mmol/L and mg/dL) throughout. This is a clinician decision-support tool and does not constitute standalone clinical guidance. · Full clinical reference & guideline sources →