Methodology: the 10-year risk uses the Pooled Cohort Equations (Goff DC et al., 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk, Circulation 2013;129:S49–S73), applicable to adults aged 40–79 without known ASCVD, LDL <190 mg/dL, and not already on high-intensity statin therapy. For ages 20–59, lifetime risk uses the categories from Lloyd-Jones DM et al. (Circulation 2006;113:791–798) — risk of "hard CVD" (fatal/nonfatal coronary heart disease or stroke), followed to age 95. For ages 60–79, lifetime risk instead uses Berry JD et al., "Lifetime Risks of Cardiovascular Disease", N Engl J Med. 2012;366:321–329 (the Lifetime Risk Pooling Project, same risk-factor categories, same investigator group) — specifically its "death from cardiovascular disease" outcome, anchored at age 65 or 75 and followed to age 90. These are two different outcome definitions shown on the same page for continuity of coverage; they are not directly comparable to each other. The equations are validated for White and African American populations; for other races/ethnicities the result is approximate. eGFR uses the CKD-EPI 2021 race-free creatinine equation (Inker LA et al., NEJM 2021;385:1737–1749).

Lifetime risk, "all factors optimal" reference (ages 60–79): of the 4 age-anchor/sex combinations for this category, Berry 2012 only publishes one (men, age-75 anchor: 20.7%) — the paper reports no reliable estimate for the other three, citing sample size and follow-up limitations. Rather than show a bare "N/A" for those, the app approximates the missing figure from the ratio between "all optimal" and "not optimal" observed in the one published combination (20.7% ÷ 18.7% ≈ 1.107×), applied to the "not optimal" value of the missing combination (which is published for every anchor/sex). This is an internal-consistency approximation, not a value from the source paper — every place it appears is marked "≈" with "estimated" in its label, and is never presented with the same confidence as a directly published figure. It only ever affects patients who fall in the "all factors optimal" category at ages 60–79; every other lifetime-risk figure on this page is a number published directly in the source study.

Recurrence risk / SMART2 (Results tab, secondary prevention): the 10-year ASCVD risk, lifetime risk and TORI above are validated only for primary prevention — patients without known cardiovascular disease. The "Prior cardiovascular event" toggle is the first question on the Input tab for this reason: turning it on hides those primary-prevention cards entirely (rather than showing them alongside a caveat) and shows SMART2 (Second Manifestations of ARTerial disease), a competing-risk model estimating 10-year risk of a recurrent major vascular event, per Kaasenbrood, Dorresteijn et al., Eur Heart J. 2022;43(18):1715–1727 (made available via the ESC CVD risk prediction app and u-prevent.com), recalibrated to the patient's geographic region using the same expected/observed-ratio approach as SCORE2. Provenance caveat: the paper itself does not publish its full coefficient table, so the coefficients used here come from a spreadsheet reconstructed by the app's user from public sources, not copied from the paper's own supplementary material. It was cross-checked before use: five coefficients (male sex, current smoking, diabetes, cerebrovascular disease, antithrombotic therapy) match hazard-ratio fragments independently found in the published paper's excerpts, and the reconstruction reproduces the same output as the official u-prevent.com SMART2 calculator for a test case — good corroboration, but not the same as independently verifying the primary source's own table.

SMART2 — full methodology & provenance note

SMART2 (Second Manifestations of ARTerial disease) — Kaasenbrood, Dorresteijn et al., Eur Heart J. 2022;43(18):1715–1727, made available via the ESC CVD risk prediction app and u-prevent.com. Provenance: this paper does not publish its full coefficient table; the coefficients used here come from a spreadsheet reconstructed from public sources, cross-checked two ways before use — five coefficients (male sex, current smoking, diabetes, cerebrovascular disease, antithrombotic therapy) match published hazard-ratio fragments found independently, and the reconstruction reproduces the same result as the official u-prevent.com SMART2 calculator for a test case. Treat this as a well-corroborated reconstruction, not an independently-verified official release. Recalibrated to the selected geographic risk region using the same expected/observed ratio approach as SCORE2.

BMI/eGFR/IMT/LVH (Organ damage tab): these are not variables in the ASCVD/Lifetime formula — no published equation combines them with age/cholesterol/blood pressure into a single validated score. They are shown as additional risk factors / organ damage (CKD, obesity, IMT, left ventricular hypertrophy) that the ACC/AHA 2018 guidelines use to inform clinical decision-making in borderline or intermediate risk cases, without altering the calculated percentage. The icons are original illustrative pictograms (body silhouette, kidney, artery cross-section, heart), colored by category, not diagnostic images.

Target Organ Risk Index — TORI (Organ damage tab, experimental): an additional, clearly-marked "experimental" card applies a correction factor to the 10-year ASCVD risk based on the same four organ-damage markers (LVH, eGFR/CKD stage, carotid IMT, BMI), using an additive relative-weight model with a capped multiplier (weights summed, capped at +150%, i.e. up to a ×2.5 multiplier) adapted from a conceptual framework proposing this approach for SCORE2 (not from a validated clinical study). Because this app does not implement SCORE2 (its official coefficients are not publicly available), the correction is applied to the Pooled Cohort Equations ASCVD estimate instead — a further extrapolation beyond what the source framework itself supports. The per-finding weights are approximate, not individually re-derived or statistically fitted for this app, and the combined model has not been validated against outcomes. It is shown for exploratory/discussion purposes only, never as a substitute for the two validated risk numbers above, and is never blended into them. The specific weighting formula is proprietary and not published within the app. Not a validated clinical instrument: there has been no calibration, no internal or external validation, and no comparison against real outcomes — treat it as a talking point for clinical discussion, never as a basis for treatment decisions.

Known limitations: this tool does not replace clinical judgment or local guidelines (e.g. SCORE2 for European populations, whose full coefficients are not publicly available in the original paper — see separate note). It does not include other "risk-enhancing" factors (family history, hs-CRP, coronary artery calcium, etc.).