Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 54 10 2025 11 01 2275 2283 Mohammad-Shafi Mojadadi Department of Immunology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran Fatemeh Shahnazari Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran Mohammad Kolyaie Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran Hesamuddin Gordan Department of Internal Medicine, School of Medicine, Vasei Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran Amir Raoofi Department of Anatomy, Sabzevar University of Medical Sciences, Sabzevar, Iran Rahim Golmohammadi Department of Anatomy, Sabzevar University of Medical Sciences, Sabzevar, Iran Saeideh Sadat Shobeiri Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran Safoora Pordel Clinical Biochemistry Research Center, Basic Health Sciences Institute, Sharhakord University of Medical Sciences, Shahrkord, Iran 2025 05 01 2025 08 13 Background: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality. This study assessed the 10-year ASCVD risk and evaluated 5-year follow-up outcomes among adults in the Sabzevar PERSIAN Cohort Center, northeast Iran. Methods: Baseline data were collected in 2018, with follow-up completed in 2023. Risk factors including age, gender, blood pressure, cholesterol levels, smoking status, and diabetes were assessed. The 10-year ASCVD risk was calculated using the American College of Cardiology's risk estimator and categorized as low (<5%), borderline (5–7.4%), intermediate (7.5–19.9%), or high (≥20%). A Cox proportional hazards model evaluated the association between age, gender, diabetes, and ASCVD events. Results: Among 2,871 participants, men had higher blood pressure, while women had higher levels of total cholesterol, HDL, and LDL (P < 0.05). Hypertension was more prevalent in men than in women (P < 0.001). Diabetes was present in 13.8% (n = 397) of participants, with no significant difference between men and women. The distribution of 10-year ASCVD risk was as follows: low (74.58%), borderline (9.3%), intermediate (13.96%), and high (2.16%). Men had a significantly higher ASCVD risk than women (P < 0.001). During the 5-year follow-up, 1.2% (n = 34) of participants experienced ASCVD events. In multivariable analysis, age (P < 0.001), male gender (P < 0.001), and diabetes (P = 0.013) were significant predictors of ASCVD events. Conclusion: ASCVD risk estimation and early intervention, particularly for older adults and individuals with diabetes, are essential. These findings support targeted prevention efforts in northeast Iran and similar populations. https://ijph.tums.ac.ir/index.php/ijph/article/view/38964 https://ijph.tums.ac.ir/index.php/ijph/article/download/38964/8685