The Agatston score quantifies coronary artery calcium (CAC) using noncontrast electrocardiogram-gated low-dose X-ray computed tomography, providing a measure of the extent of calcified atherosclerotic plaque in the coronary arteries.
The test uses a specialized CT scan to detect calcium deposits in coronary arteries.
Calcium in coronary arteries indicates the presence of atherosclerotic plaque.
Each calcified lesion is scored based on its area and density, and the scores from all lesions are added together to produce the total Agatson score.
Score: 0: No identifiable plaque (very low risk) 1-10: Minimal plaque (low risk) 11-100: Mild plaque (moderate risk) 101-400: Moderate plaque (moderately high risk) Over 400: Extensive plaque (high risk)
A higher Agatston score is strongly associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD).
For instance, patients with CAC scores ≥100 Agatston units typically have a 10-year ASCVD risk ≥7.5%, which is a threshold for initiating statin therapy according to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines.
The Agatston score can serve as a surrogate marker for biological age, often referred to as the arterial age.
The arterial age, derived from CAC scores, can be more predictive of short-term incident coronary events than chronological age alone.
Accelerated aging is associated with increased inflammation and atherosclerosis, both of which contribute to higher CAC scores.
The Agatston score’s ability to predict future cardiovascular events underscores its importance in managing age-related diseases.
A CAC score of zero is associated with a very low risk of cardiovascular events in the short term, while higher scores indicate a need for aggressive risk factor modification, including lifestyle changes and pharmacotherapy.