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Primary prevention only

Pooled Cohort Equations apply to adults 40-79 without prior clinical ASCVD. Patients with a prior stroke, MI, or other clinical ASCVD are already in secondary prevention and require statin therapy regardless of the PCE result. Use the Post-Stroke Lipid Management pathway instead.

Demographics

Lipids and blood pressure

Conditions

Limitations

  • The PCE was derived from four U.S. cohorts. It may overestimate risk in contemporary populations and underestimate risk in some non-White, non-AA groups.
  • Race-specific coefficients reflect historical cohort composition, not biology. They are imperfect and under active revision.
  • The PCE does not apply to patients with prior clinical ASCVD. Those patients need statin regardless of calculated risk.
  • Risk-enhancing factors (family history of premature ASCVD, Lp(a) ≥50 mg/dL, persistent LDL-C ≥160, CKD, metabolic syndrome, ApoB ≥130, ABI <0.9, chronic inflammation, pre-eclampsia history, early menopause) should refine the decision at borderline or intermediate risk.
  • Coronary artery calcium scoring can refine the decision when risk is intermediate and clinical judgement is uncertain.

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