Your cumulative atherogenic burden, quantified
Atherosclerosis is driven not just by how high your LDL is, but by how long it has been elevated. Plaque Years integrates both the magnitude and duration of LDL exposure into a single measure of lifetime atherogenic burden.
Patient inputs
Risk category
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Select medications. One combined trajectory is shown on the chart.
Cumulative exposure over time
Plaque Years integrates LDL cholesterol concentration over time — analogous to pack-years in smoking. It captures the dual importance of both magnitude and duration of LDL elevation in driving atherosclerotic plaque development. Using Mendelian randomization and cohort data, Ference et al. identified two key anchors: 5,000 mg/dL·years (MI risk exceeds 1%) and 8,000 mg/dL·years (mean cumulative burden at average age of first MI).
Reductions are applied multiplicatively to the current LDL. High-intensity statin: ~50%. Ezetimibe: ~20% additional. PCSK9 inhibitor: ~60% additional. Multiple medications combine multiplicatively.
LDL is assumed constant at the earliest known value from birth, meaning without historical readings, plaque years equals current LDL × age. When multiple time points are provided, LDL is linearly interpolated between readings and the cumulative area is computed via trapezoidal integration.
Ference et al. established that once the cumulative LDL threshold has been exceeded, the risk of experiencing an MI in response to continued plaque growth increases log-linearly. This calculator models that relationship as a risk that doubles with every additional 1,250 plaque years accumulated beyond the 5,000 threshold, beginning at 1% and rising continuously. Below 5,000 plaque years, risk is reported as <1%.
The 2026 ACC/AHA guidelines place a renewed emphasis on low LDL goals. They recognize that lifetime atherogenic burden, not just point-in-time LDL levels, drives cardiovascular risk. The guidelines explicitly support the use of illustrative and patient-facing tools to help individuals understand why lipid-lowering medications are being added — making cumulative exposure models like Plaque Years a timely fit for both clinical decision-making and shared decision-making conversations.
Created by Alexander M. Spring, MD
References
Disclaimer: This calculator is intended for educational and clinical discussion purposes only. It is not a validated clinical decision support tool and should not replace individualized risk assessment or clinical judgment. Thresholds are derived from population-level data and may not apply to all individuals.