Coronary artery calcium (CAC) score

The coronary artery calcium (CAC) score comes from a non-contrast cardiac CT scan. It is reported as an 'Agatston score'. It measures how much calcified plaque is in your coronary arteries, a marker of total plaque burden. (It does not see soft, non-calcified plaque.) A higher CAC score is strongly tied to future heart attacks, cardiovascular events, and death. Prevention guidelines (2018 ACC/AHA, 2021 ESC) recommend CAC to re-classify risk in intermediate-risk adults. A score of zero means very low short-term risk. But it does not fully rule out atherosclerosis. That is especially true in younger adults, or those with high Lp(a) or familial high cholesterol. The standard Agatston categories: 0 (very low), 1 to 99 (mild), 100 to 399 (moderate), and 400 or more (severe). The 2026 ACC/AHA dyslipidemia guideline combines CAC with the PREVENT-ASCVD risk equations. That helps refine statin decisions in borderline-risk adults.

Last reviewed: June 22, 2026

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