This study examines the association between social determinants of health (SDOH) at individual and area levels with atherosclerotic cardiovascular disease (ASCVD) risk. It also assesses whether adding individual- and area-level SDOH to the pooled cohort equations (PCEs) or the Predicting Risk of CVD Events (PREVENT) equations improves the accuracy of risk estimates. The study included data from four large US cohort studies, with 26,316 participants aged 40 to 79 years without a history of ASCVD. The median follow-up was 13.0 years. Key findings show that both individual- and area-level SDOH, including low education, low income, and unemployment, were associated with increased ASCVD risk. Adding area-level SDOH alone to the PCEs did not improve model discrimination but modestly improved calibration. Adding both individual- and area-level SDOH to the PCEs modestly improved discrimination and calibration in non-Hispanic Black individuals. Adding individual-level SDOH to the PREVENT plus social deprivation index (SDI) equations modestly improved calibration in non-Hispanic Black and White individuals. The study suggests that both individual- and area-level SDOH may be considered in future development of ASCVD risk assessment tools, particularly among Black individuals. The findings highlight the importance of SDOH in cardiovascular health and suggest that incorporating these factors could improve the accuracy of risk estimates for ASCVD. The study also notes that SDOH may confer ASCVD risk equivalent to or greater than traditional risk factors. The results indicate that SDOH should be considered in future risk assessment tools to better account for social factors influencing cardiovascular health.This study examines the association between social determinants of health (SDOH) at individual and area levels with atherosclerotic cardiovascular disease (ASCVD) risk. It also assesses whether adding individual- and area-level SDOH to the pooled cohort equations (PCEs) or the Predicting Risk of CVD Events (PREVENT) equations improves the accuracy of risk estimates. The study included data from four large US cohort studies, with 26,316 participants aged 40 to 79 years without a history of ASCVD. The median follow-up was 13.0 years. Key findings show that both individual- and area-level SDOH, including low education, low income, and unemployment, were associated with increased ASCVD risk. Adding area-level SDOH alone to the PCEs did not improve model discrimination but modestly improved calibration. Adding both individual- and area-level SDOH to the PCEs modestly improved discrimination and calibration in non-Hispanic Black individuals. Adding individual-level SDOH to the PREVENT plus social deprivation index (SDI) equations modestly improved calibration in non-Hispanic Black and White individuals. The study suggests that both individual- and area-level SDOH may be considered in future development of ASCVD risk assessment tools, particularly among Black individuals. The findings highlight the importance of SDOH in cardiovascular health and suggest that incorporating these factors could improve the accuracy of risk estimates for ASCVD. The study also notes that SDOH may confer ASCVD risk equivalent to or greater than traditional risk factors. The results indicate that SDOH should be considered in future risk assessment tools to better account for social factors influencing cardiovascular health.