Objective  To predict the risk of atherosclerotic cardiovascular disease (ASCVD) incidence in the elderly population based on a risk assessment model, thereby providing evidence for implementing risk factor interventions among high-risk older adults to delay or prevent the onset of ASCVD.

Methods  A random cluster sampling method was employed to select 47 community health service centers in Shenzhen. All older adults (aged ≥ 65 years) who received the health management services of the National Essential Public Health Services Program from January 1, 2018 to December 31, 2022 were included as participants. General information and physical examination results were collected. The China-PAR risk assessment model was used to calculate the 10-year risk scores and stratify the risk levels of ASCVD among the older adults.

Results  This study included a total of 94 362 older adults (aged ≥ 65 years) from 2018 to 2022, comprising 41 552 males (44.03%) and 52 810 females (55.97%), with a mean age of (72.40 ± 5.42) years. Within the cohort, 14.68% were affected by diabetes, 34.59% by hypertension, and 8.11% by a combination of both diseases. The median 10-year ASCVD risk for the entire population during 2018–2022 was 11.46%, with females exhibiting a lower overall risk than males (9.57% vs. 13.50%). The median 10-year ASCVD risk exhibited an overall increasing trend among the older adults in Shenzhen from 2018 to 2022, with values of 11.20% in 2018, 11.40% in 2019, 11.55% in 2020, 11.51% in 2021, and 11.46% in 2022. Differences in ASCVD risk were identified across sex (χ² = 256.081), district (χ² = 258.537), and hypertension/diabetes status (χ² = 668.698) (all P < 0.001). Risk stratification revealed that low- and intermediate-risk individuals had higher proportions (1.30% and 37.36%, respetively) in 2018 and high-risk individuals had a higher proportion (64.61%) in 2020. Females predominated in the low- (95.40%) and intermediate-risk (86.04%) groups, whereas males constituted a majority (61.32%) in the high-risk group. High-risk individuals were the most prevalent across all chronic disease statuses. Geographical analysis showed that Longhua had the highest prevalence of low-risk individuals (22.18%), while Longgang led the moderate-risk group (23.69%). High-risk elderly individuals were primarily distributed across Longgang (25.59%) and Longhua (21.54%).

Conclusions  The 10-year ASCVD risk among the older adults in Shenzhen showed an increasing trend from 2018 to 2022. Essential public health services should strengthen the early identification of ASCVD risk factors and implement timely, risk-based stratified management, particularly targeting elderly males with chronic conditions or comorbidities.