Background: Predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk in the Pooled Cohort equation increases substantially with age. Some older adults have estimated ASCVD risk ≥7.5% without elevated risk factors; it is unclear whether the observed ASCVD risk is high in this group. We compared the incidence of ASCVD between adults with an estimated 10-year ASCVD risk ≥7.5% based on age alone vs those with elevated risk factors. Methods: Adults ages 45-79 enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study without a history of ASCVD, diabetes mellitus, or statin use were included (i.e, a primary prevention subset). Ten-year ASCVD risk was estimated using the Pooled Cohort Risk Equation. Participants were categorized into 3 groups according to the predicted ASCVD risk: Results: Among 10,742 participants, 891 ASCVD events occurred over a median follow-up of 11.1 (7.1 - 13.0) years. The “age-only” risk ≥7.5% group included 352 (3.3%) participants with mean age 69.9 ± 5.0. The risk Conclusions: Few adults in this primary prevention population had predicted risk ≥7.5% based on age alone. Even without elevated risk factors, adults with predicted ASCVD risk ≥7.5% based on age alone experienced substantial event rates consistent with their predicted risk.