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Introduction: The Kaiser Permanente ASCVD Risk Estimator (KPARE) was developed to address the systematic overestimation of actual ASCVD risk by the ACC/AHA ASCVD Pooled Cohort Equation (ACC/AHA PCE) in contemporary populations. We evaluated the accuracy and generalizability of KPARE for estimating 10-year ASCVD risk in eligible primary prevention, community-based populations in the U.S. and Canada, as compared with the ACC/AHA PCE. Methods: We identified adults 40-79 years old in 3 contemporary U.S. populations (Kaiser Permanente Northern California (KPNC), Southern California (KPSC) and Northwest (KPNW), as well as adults 66-79 years old in Ontario, Canada who had LDL-C 70-189 mg/dL, no known ASCVD, diabetes or lipid-lowering therapy and had complete follow-up. Non-fatal and fatal ASCVD events were ascertained from health system electronic health records and death certificates using validated algorithms. We examined observed ASCVD event rates within deciles of predicted 10-year risk using the KPARE vs. the ACC/AHA PCE predicted risk, and calculated metrics of discrimination and calibration. Results: In eligible primary prevention validation cohorts of KPNC (N=151,409), KPSC (N=246,815), KPNW (N=46,784), and Ontario, Canada (N=60,612 adults), the KPARE showed both better discrimination and calibration (Figure) compared to the ACC/AHA PCE to predict 10-year risk of ASCVD events, with c-statistics of 0.78, 0.78, 0.79, and 0.65, respectively. Categorical net reclassification index showed the KPARE improved ASCVD risk prediction over the ACC/AHA PCE by 23% in the KPNC validation cohort, 24% in KPSC, 33% in KPNW, and 25% in Ontario, Canada. Results were similar when stratified by race-gender subgroups. Conclusions: The new Kaiser Permanente ASCVD Risk Estimator provides more accurate ASCVD risk estimates in various community populations than the ACC/AHA PCE and may provide greater utility in shared decision-making for primary prevention strategies. [ABSTRACT FROM AUTHOR]