A newly updated online tool from the American Heart Association (AHA) is providing individuals with a clearer, and sometimes surprising, picture of their likelihood of developing cardiovascular disease. The calculator, which estimates a person's 10-year risk for heart attacks, strokes, and heart failure, underscores that while lifestyle choices are critical, the two most significant factors are entirely beyond one's control: age and biological sex.
Controllable Risks: Smoking, Diabetes, and Blood Pressure
The interactive tool allows users to adjust various health metrics to see their impact. The results powerfully highlight the dangers of smoking. For instance, a 70-year-old man with otherwise healthy vitals has an 11.4% risk of cardiovascular disease in the next decade. If that same man has smoked within the past 30 days, his risk jumps to 14.9%.
Dr. Ashish Sarraju, a preventive cardiology specialist at the Cleveland Clinic, emphasises this point, stating, "Smoking is absolutely the No. 1 thing we should address. There is almost nothing we can do that benefits a person as much as quitting smoking." He explains that smoking elevates blood pressure and increases the risks of blood clots, inflammation, and arterial plaque.
Diabetes is another major amplifier of risk. That same hypothetical healthy 70-year-old man sees his risk rise from 11.4% to 16.6% if he has diabetes. High blood pressure (hypertension) is equally critical. Increasing systolic pressure from 120 to 160 raises the risk from 11.4% to 15.6%.
The calculator also factors in the use of blood pressure medication, which may initially seem to increase the calculated risk. This is because the tool assumes that someone on medication has a history of hypertension, which has already caused some damage. Doctors strongly advise using medication if lifestyle changes alone cannot control high blood pressure.
The Surprising Link: Kidney Health as a Heart Warning
One of the more insightful aspects of the revamped calculator is its inclusion of kidney function, measured by estimated glomerular filtration rate (eGFR). Poor kidney health is now recognised as a significant warning sign for heart disease.
This connection exists because the same conditions that damage blood vessels in the heart—primarily high blood pressure and diabetes—also harm the kidneys' delicate filtering systems. Therefore, a declining eGFR often indicates that the heart and brain may also be suffering from vascular damage.
Weight, Cholesterol, and Unchangeable Factors
The tool also considers cholesterol levels (both total and HDL 'good' cholesterol) and Body Mass Index (BMI). However, the AHA clarifies that a high BMI alone is not a direct risk factor, as some obese individuals remain metabolically healthy. Conversely, some people with normal weight can be metabolically unhealthy and at higher risk.
Ultimately, the most dominant factors are immutable. The older you are, the higher your risk. Furthermore, men are consistently at a greater risk than women of the same age. Inputting an older age into the calculator makes the risk percentages soar dramatically.
Despite this sobering reality, there is good news. Dr. Sarraju notes, "We know that aging isn't something we can change. We're going to do best so that you die with heart disease not because of heart disease." Deaths from heart disease have fallen in recent decades due to declining smoking rates and the development of powerful drugs to manage hypertension, diabetes, obesity, and high cholesterol.
The AHA's calculator, updated in December 2025, serves as a vital educational resource. It empowers people to understand their personal risk landscape, reinforcing the importance of managing controllable factors like smoking, blood pressure, and blood sugar to mitigate the unavoidable risks of aging and genetics.
