[24-27] The Veterans Affairs Risk Score for Cardiovascular Disease (VARS-CVD) is an option to calculate a five-year risk using the fully calibrated version to improve the accuracy of the CVD risk estimation.[28] Although several risk calculators exist, the Work Group does not recommend one over another as comparison studies were not evaluated.[26] Below are the commonly used risk calculators that providers should consider to calculate the 10-year risk and determine the need for lipid-lowering medication. Providers should consider their patient population characteristics when selecting a risk calculator. However, it should be noted that there is a potential for over- or under-estimation of 22 24% of CV risk with each risk calculator, which may result in over- or under-treatment.[26] Since every calculator has limited accuracy, providers will inevitably prescribe medications for patients who may not benefit from pharmacotherapy and withhold medications from patients who may have otherwise benefited from treatment.[27] FRS: a tool used to estimate the 10-year risk of having a CV event (not including stroke)b PCE: a central tool recommended by the American College of Cardiology/American Heart Association (ACC/AHA) based on a 10-year CVD risk estimation from a pooled cohort equationc VARS-CVD: a five-year risk score calculator only for the VA population using the information available in the VA Electronic Health Record (EHR)d For more information on CVD risk calculators, see Appendix B. Despite the known imprecision of risk calculators, they help identify patients who may benefit the most from treatment for primary prevention with statin therapy. In clinical practice, providers commonly use the FRS or the PCE to calculate a 10-year CV risk estimation. Evidence supports the use of the revised or updated PCE for African American men and women and those with a history of DM.