ASCVD 10-Year Visualization

Graphically analyze the 10-year ACC/AHA atherosclerotic cardiovascular disease (ASCVD) Pooled Cohort Equations

Sex-Race Analysis
Sex-Race
Risk Factor Analysis
Risk Factor
3D Graph Analysis
3D Graph
Compare sex- (male/female) and race- (non-black/black) specific ASCVD risks

X-axis (continuous)
Y-axis (continuous)
Animate
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  • Use your mouse to rotate the 3-dimensional graph. Rotation is not possible while an animation is running.
  • Zoom in/out using your mouse wheel or the +/- buttons in the top-right corner

About This Calculator

This graphing tool is intended for advanced clinicians wanting to visualize (and geek out) on the ACC/AHA Pooled Cohort Equations 10-Year ASCVD (atherosclerotic cardiovascular disease) risk calculations.1 If you are looking to calculate the risk for an individual patient, check out our standard 10-Year ASCVD Calculator.

The Black Box Phenomenon

Black Box by http://www.sxc.hu/profile/jelaga

The Pooled Cohort Equations are a collection of complex linear regression models with approximately 13 coefficients to calculate a patient's 10-year ASCVD risk. Unlike other risk models where a clinician can hand calculate, this model is too complex. Because of this complexity, a "black box" phenomenon is introduced -- a patient's risk factors are fed into a "black box" and an ASCVD risk is magically produced. The clinician is left with a poor understanding of how the calculation is produced and the relative weight or importance of each risk factor.

Unique Visualizations

ASCVD visualization can produce interesting patterns in the Pooled Cohort Equations that may have otherwise gone unnoticed.

As an example, black female patients with low HDL cholesterol express particularly high ASCVD risk early in life that actually DECLINES with age. All other models have increasing ASCVD risk as age increases:

10-year ASCVD risk graph - Black female patients with low HDL cholesterol display a paradoxical DECLINE in 10-year ASCVD risk as they age
TC 245 mg/dL, HDL 20 mg/dL, systolic BP 186 mmHg (treated)

Another interesting phenomenon is a "U"-shaped curve as age increases with non-black females, which is exaggerated with elevated risk factors:

10-year ASCVD risk graph - Non-black female patients demonstrate a unique 'U'-shaped ASCVD risk profile, particularly with exaggerated risk factors
TC 224 mg/dL, HDL 20 mg/dL, systolic BP 154 mmHg (treated), smoker, diabetic

These patterns are interesting because they do not make intuitive sense. Given the complexity of the Pooled Cohort regression models, these effects could be an unintended consequence or a true effect. Regardless, graphical visualization allows clinicians interested in the model to view these patterns and be aware that there may be limitations as patients approach the maximums of the risk factor ranges (such as very low HDL).

References and Additional Reading

  1. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. doi: 10.1161/‚Äč01.cir.0000437741.48606.98.

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Updated Jan 18, 2016
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