A Coronary Artery Calcium (CAC) score, often called the Agatston score, is a diagnostic tool used to assess a person’s risk of experiencing a future heart attack or stroke. It is derived from a specialized CT scan that quantifies the amount of calcified plaque present in the walls of the coronary arteries. This measurement directly reflects the burden of long-term atherosclerosis, which is the root cause of most serious cardiovascular events. The CAC score provides an individualized risk assessment that can significantly improve upon traditional risk factor calculations, helping to guide preventive treatment and lifestyle changes.
What the Coronary Artery Calcium Test Measures
The CAC test is a non-invasive procedure utilizing a computed tomography (CT) scanner to create detailed images of the heart’s arteries. This scan specifically detects and measures calcium deposits that have formed within atherosclerotic plaque. This calcification is a marker of long-term disease progression within the artery walls.
The resulting Agatston score is calculated by factoring in both the total area of the detected calcium deposits and their density. A higher score translates to a greater volume and density of calcified plaque, indicating a more extensive burden of atherosclerosis. While the score does not measure the severity of any actual arterial blockage, the extent of calcified plaque is strongly correlated with an increased risk of a future cardiovascular event.
How CAC Scores Are Categorized
Healthcare providers interpret the Agatston score by placing the result into risk categories to stratify a person’s risk of heart disease. A score of zero indicates no detectable calcified plaque, suggesting a very low risk of a heart attack over the next decade. This finding is often used to downgrade risk for people who might otherwise be considered intermediate-risk based on other factors.
Scores between 1 and 100 represent minimal to mild calcification, which is associated with a low to moderate risk of a future coronary event. The moderate category spans scores from 101 to 400, signifying an established amount of plaque and a significantly increased risk of cardiovascular events. Finally, a score exceeding 400 represents extensive calcification, which places an individual in the severe or very high-risk category.
Significance of a Score of 250
A Coronary Artery Calcium score of 250 falls within the Moderate Calcification category (101 to 400 Agatston units). This score indicates established and substantial coronary atherosclerosis, even if the person has never experienced symptoms. A score in this range suggests a high probability that plaque is present in multiple coronary arteries, representing a notable burden of disease.
A score of 250 is associated with a moderately high risk of experiencing a major cardiac event, such as a heart attack or cardiac death, typically estimated to be in the 10–20% range over the next ten years. For every doubling of the CAC score, the relative risk of a future event increases by approximately 14%. The interpretation of this score is further refined by considering the age and sex percentile, which compares the individual’s score to others of the same age and sex.
A score of 250 in a younger individual, such as a 45-year-old, indicates a significantly accelerated rate of atherosclerosis compared to their peers. This finding is more concerning than the same score in an 80-year-old, as it suggests a much longer duration of exposure to risk factors and greater lifetime risk. A score of 250 typically mandates a more aggressive approach to preventive care, moving the patient from an intermediate-risk profile to a high-risk one regardless of other traditional risk factors.
Required Follow-up and Risk Reduction Strategies
Receiving a CAC score of 250 requires immediate follow-up with a healthcare provider, ideally a cardiologist or a primary care physician specializing in cardiovascular risk reduction. This level of calcification is a clear signal to initiate aggressive risk factor modification to slow the progression of atherosclerosis and prevent future events. The primary medical strategy involves aggressive lowering of low-density lipoprotein cholesterol (LDL-C), typically achieved through the initiation of statin therapy.
For a score in the 250 range, high-intensity statin therapy is often recommended to achieve a substantial reduction in LDL-C, sometimes targeting a level below 70 mg/dL. Blood pressure and blood sugar must also be managed tightly, as these factors accelerate plaque growth and stability. Alongside medication, crucial lifestyle modifications include adopting a heart-healthy diet, establishing a regular exercise regimen, and achieving complete smoking cessation. These actions form the foundation of a comprehensive treatment plan aimed at reducing cardiovascular risk.