Does anyone know the Agatston Coronary Calcium Score Guidelines?

I means there is a lot of calcified plaque in your coronary arteries. Check with you cardiologist. I had a 1325 score before my bypass operation.

@lenmayo

Oh, wow!!!
I am following the Agatston coronary calcium guidelines that says anything over 300 means there is extensive calcium build up and a significantly higher risk for coronary artery disease. I will ask my cardiologist, but also see if the American Heart Association has anything posted. Thanks for your input.

99th percentile means you have more plaque than 99% of women your age.

@njx58
Thanks!
Gives me more information to ask my cardiologist.
Surprised that the CT scan summary did not raise it in more detail.

Hi @ewei6911

Mayo Clinic has an overview of the Coronary Artery Scan you are referencing. I will include the link and also copy the “Results” section that addresses the Agaston Score.

Keep in mind that results shouldn't be used as a single sign of your overall health and risk of heart disease. The information from the scan should be reviewed with other health information.

RESULTS
Coronary calcium scan results are usually given as a number. The number is called the Agatston score. The score is the total area of calcium deposits and the density of the calcium.
- A score of zero means no calcium is seen in the heart. It suggests a low chance of developing a heart attack in the future.
When calcium is present, the higher the score, the higher the risk of heart disease.
- A score of 100 to 300 means moderate plaque deposits. It's associated with a relatively high risk of a heart attack or other heart disease over the next 3 to 5 years.
- A score greater than 300 is a sign of more extensive disease and a higher heart attack risk.

The test score also may be given as a percentage. The number is the amount of calcium in the arteries compared to other people of the same age and sex. Calcium scores of about 75% have been linked with a significantly higher risk for heart attacks.

Here is the complete Overview
- Mayo Clinic Coronary Calcium Scan Overview
https://www.mayoclinic.org/tests-procedures/heart-scan/about/pac-20384686
Would you share more about what led you to get a CT Angio Heart and Coronary Artery Scan done? Also, what is next?

@jlharsh
Thanks for the Agatston info.
The Agatston score was included in the results of a CT scan of my aortic aneurysm, stomach, and pelvis. The size of my aneurysm was 4.1 cm which is a concern because my previous scan in February 2026, the size was 4.8 cm. It was 4.6 cm in November 2024. My cardiologist asked a thoracic surgeon to review the films of the last 2 scans and I am currently waiting for the surgeon's opinion. I am calling my cardiologist to ask what he recommends on the Agatston score since it seems to have been overlooked in the concerns about the aneurysm sizes.

You bet, @ewei6911

You mention the size of your aneurysm has decreased from 4.8 to 4.1cm since February. What concerns do you have?

I am glad to hear you plan to contact your cardiologist about your 1000+ coronary calcium score. Will you come back and let me know what you find out?

I've been down a road similar to the one you are on. I got a CAC test and found I was in the 98th percentile for my age. I was in my early 60's at the time. The score itself was around 600. My arteries were/are older than you according to a research-backed calculator apparently. 🙂

What it meant for me was getting testing to try to determine if there was an actual blockage. The CAC (I think) measures roughly the volume of plaque. If you think of atherosclerosis as crud in a pipe, the same volume of crud could be all along the pipe and not really block blood flow or it could all be in one place and come closer to blocking the flow. And you have multiple coronary arteries. I got a nuclear stress test first and then I also got a CT coronary angiogram. The CT angiogram showed no blockages greater than 50% (where the level at which they may intervene is around 70 I think).

What it has meant for me long term is going on LDL lowering medication (they want LDL < 55), monitoring my diet more strictly, and trying to improve my aerobic fitness. There's no way I know of to "reverse" accumulated plaque, but the progress can be slowed down substantially. They also can't predict if/when/who will have a problem. So you just have to accept it.

Frankly, it's also meant some worry. It was a turning point in my life. There's my life before and my life after the CAC test (the test also revealed a 4.5cm ascending aortic aneurysm). But, it gets better as time goes by. There are lots of comforting thoughts to help one live with it. I'd guess they are very individual.

Good luck. Many people never have a problem even with a high CAC score. I'm doing all I can to be one of those. Your doctor should talk through lifestyle interventions with you. There's lots of information online as well.

@jlharsh
My cardiologist is focused on the size of my aneurysm now. Before the March 25th CT scan that had 4.1 cm aneurysm size, there was an Echocardiogram that showed a 4.6 cm aneurysm, but my cardiologist said echos get only a partial view and a CT scan is more accurate. A CT scan done on Feb. 12th was 4.8 cm. So, the scan with a decrease to 4.1 cm in a short period of time has me confused and concerned because I thought I needed surgery last February and have now delayed it.
Next time I see my cardiologist, I will ask about what can be done about the Agatston score and let you know what he says.

@bitsygirl thank you very much for your detailed reply. I'm in a similar situation, though my nuclear stress test indicated less than 70% blockage. I appreciate the comparison to sludge in a pipe-makes a lot of sense. Since on statins, 40mgs of crestor, I was able to lower my ldl from 115 to 43. I also learned that plaque can begin to be eliminated so long as the ldl is below 50. So there is some hope that with continued statin, more plant based dieting, and exercise, I may continue to improve.