Pesticide Exposure Cardiovascular Risk Composite (PE-CRC) Calculator

Primary exposure setting -- choose -- No known exposure Environmental/household use Occupational – typical handling Occupational – high exposure (mixing/spraying without controls, historical high levels) Exposure duration (years) Predominant pesticide class (optional) -- not specified -- No specific class Organophosphate (OP) Pyrethroid Carbamate Multiple classes / mixtures Type 2 diabetes -- choose -- No Yes Pesticide Exposure Cardiovascular Risk Composite (PE-CRC): Rationale, Intended Use, and Evidence Base This tool is designed to translate published epidemiologic signals into a pragmatic, patient-level adjustment of an existing 10-year ASCVD risk estimate. You supply a baseline absolute risk (from a validated calculator, e.g., ACC/AHA Pooled Cohort Equations), then the calculator applies a composite multiplier reflecting pesticide exposure setting, duration, suspected class/mixtures, and the presence of type 2 diabetes (T2DM). The output is a pesticide-adjusted 10-year CVD risk and a simple risk category, with an additional “original-study mode” that reproduces the adjusted hazard ratio observed for high occupational exposure in the Kuakini Honolulu Heart Program.

Key empirical anchors • Berg ZK, et al., J Am Heart Assoc 2019;8(19):e012569 — HR 1.42 for high occupational exposure. • Zhao X, et al., Chemosphere 2024 — elevated CVD mortality with household pesticide exposure. • Wu X, et al., Chemosphere 2025 — stronger ASCVD effects in T2DM subgroups. • He J, et al., Front Nutr 2025 — mechanistic review linking pesticides and cardiovascular health. • Zhao L, et al., 2023 — meta-analysis finding no consistent OP–CVD association. Clinical interpretation The PE-CRC yields an adjusted absolute risk to contextualize counseling, exposure mitigation, and threshold-based decisions that already rely on ASCVD risk. Treat the adjusted value as an adjunct, not a replacement, for guideline-based calculators.

Limitations The model uses multiplicative scaling derived from hazard ratios and conservative estimates. It has not been externally validated for event prediction and should be used primarily for clinical discussion and research exploration. References Berg ZK, Rodriguez B, Davis J, et al.

J Am Heart Assoc. 2019;8(19):e012569. Zhao X, et al.

Chemosphere. 2024. Wu X, et al.

Chemosphere. 2025. He J, et al.

Front Nutr. 2025. Zhao L, et al.

2023.