Imaging
Coronary CT calcium score
CAC · Agatston score · Coronary artery calcium
A direct visualisation of coronary atherosclerosis — refines cardiovascular risk far more sharply than any single blood marker.
What it measures
Non-contrast CT scan quantifying calcified plaque in the coronary arteries. The Agatston score sums calcium-area × density across the four major coronary territories. A score of zero is a powerful negative predictor; rising scores predict events in a dose-dependent way.
Reference context
4 guideline sources
Age- and sex-adjusted percentiles (MESA calculator) are more informative than the absolute score for adults under 60, because absolute scores rise with age. A score of 50 at age 45 is more concerning than a score of 200 at age 75.
Population context — consult guideline targets below
Mechanism
Why moving this marker matters
Coronary calcification is a marker of established atherosclerotic plaque burden. While vulnerable plaque is non-calcified, total plaque burden (including the calcified component visible on CT) is strongly correlated with event risk. Mendelian-randomisation and prospective cohort data both support causal inference.
Guideline targets
What major guidelines recommend
ACC/AHA — CAC 0
Very low 10-year ASCVD risk; statin generally deferrable in absence of other risk factors.
ACC/AHA — CAC 1–99
Mildly elevated burden; lifestyle plus consideration of pharmacotherapy depending on absolute risk.
ACC/AHA — CAC 100–299
Moderate burden; statin therapy generally indicated.
ACC/AHA — CAC ≥300 or ≥75th percentile for age/sex
High burden; aggressive risk-factor modification.
How to measure
The test, where to get it, when to repeat
Method
Non-contrast CT scan, ~10 minutes, single breath-hold. Radiation dose ~1 mSv (similar to mammography).
Where
Hospital cardiology imaging or specialist private clinic; increasingly available through preventive-health providers (Prenuvo, Ezra, Neko Health, longevity clinics).
Typical cost
€150–500 private; rarely covered by public systems unless symptomatic.
Fasting
Not required
When to test
ACC/AHA 2018
40–75Class IIa for adults aged 40–75 at borderline-to-intermediate 10-year ASCVD risk (5–20%); particularly useful when decision-making about statin therapy is uncertain.
ESC 2021
40+May be considered to refine risk estimation in asymptomatic adults at moderate risk.
MESA cohort guidance
Repeat scoring after 5–7 years is informative for risk re-classification.
Where to scan
Providers offering this imaging study
These providers offer the scan directly to consumers. You book and pay with them; the imaging report lives on their platform. Healicus is not in the clinical chain.
Prenuvo
US · UK · EU · INTLWhole-body MRI screening at private clinics in major cities — radiologist-read report.
Visit Prenuvo
Prescan
DE · EUEuropean preventive-imaging chain offering MRI, CT, DEXA, and vascular screening in German clinics.
Visit Prescan
Cleerly
USAI-read coronary CT analysis — physician referral required, FDA-cleared CCTA reporting.
Visit Cleerly
Healicus is not the provider. Your contract for the service is with whoever you choose. Links labelled Sponsored are paid affiliate relationships; unlabelled links are editorial reference only. See our disclosure for the full policy.
Context
Reading the numbers
Age- and sex-adjusted percentiles (MESA calculator) are more informative than the absolute score for adults under 60, because absolute scores rise with age. A score of 50 at age 45 is more concerning than a score of 200 at age 75.
Caveats
CAC measures only calcified plaque. A zero score does not exclude soft (non-calcified) plaque, which is more common in younger adults and people with diabetes. A high score in older adults reflects historical, not necessarily active, disease.
See also
Related markers
Take to your physician
Worth discussing
- Whether your absolute risk estimate, calcium score, and percentile justify statin therapy or further imaging.
- If your score is zero, when (if ever) to repeat it.
- How to interpret rising scores between scans (progression is common; absolute rate matters more than presence of any rise).
Sources
Cited literature
Edited by Carl Pöhl, MD · Healicus editorial
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