CAC Percentile (MESA Reference) Calculator

MESA CAC Reference Calculator

Estimates the age-, sex-, and race/ethnicity-specific percentile of an Agatston coronary artery calcium score using published MESA reference values.

Age (years)

MESA reference values apply to adults aged 45–84 years.

Sex

Race/Ethnicity

These four groups correspond to the original MESA CAC reference population.

Agatston CAC Score

Enter the total Agatston coronary artery calcium score reported by CT.

About the MESA CAC Percentile

The Multi-Ethnic Study of Atherosclerosis (MESA) CAC reference values allow an observed Agatston coronary artery calcium score to be compared with the distribution of CAC among participants of the same age, sex, and race/ethnicity.

The original MESA reference population included adults aged 45–84 years who were free of clinical cardiovascular disease and treated diabetes at baseline. The reference groups were White, Black/African-American, Hispanic, and Chinese participants.

How to Interpret the Percentile

The percentile describes the relative position of the observed CAC score within the MESA reference distribution for the selected demographic group.

For example, a percentile of 75 means that the observed CAC burden is approximately higher than that of 75% of the corresponding MESA reference population.

The percentile is not a percentage probability of having a cardiovascular event. It is a measure of relative CAC burden.

MESA Reference Percentiles

25th percentile: CAC score below which approximately 25% of the reference population falls.
50th percentile: Median CAC score for the reference group.
75th percentile: CAC level exceeded by approximately 25% of the reference population.
90th percentile: CAC level exceeded by approximately 10% of the reference population.

Clinical Context

CAC percentile provides demographic context for an individual's absolute Agatston score. Both the absolute CAC score and percentile should be considered when interpreting CAC findings.

In appropriate adults undergoing CAC testing for primary prevention, CAC ≥100 AU or ≥75th standardized percentile supports lipid-lowering therapy according to current ACC/AHA guidance.

Important Limitations

This calculator is intended for adults aged 45–84 years.
The MESA reference population includes White, Black/African-American, Hispanic, and Chinese participants.
The MESA percentile is a relative measure of CAC burden and is not a direct estimate of ASCVD event probability.
The original MESA reference population was free of clinical cardiovascular disease and treated diabetes at baseline.
A CAC score of 0 does not exclude non-calcified coronary plaque.
Absolute CAC score and percentile should be interpreted together.
This implementation uses published MESA reference-value anchors with interpolation between age points. It should not be considered an exact reproduction of the original MESA statistical model or interactive MESA calculator.

References

1. McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006;113(1):30–37. doi:10.1161/CIRCULATIONAHA.105.580696.

2. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358(13):1336–1345. doi:10.1056/NEJMoa072100.

3. Blaha MJ, Cainzos-Achirica M, Greenland P, et al. Role of coronary artery calcium score in the prevention of cardiovascular disease. Current evidence and clinical application.

4. 2026 ACC/AHA Dyslipidemia Guideline. American College of Cardiology and American Heart Association.

Clinical Disclaimer

This calculator is intended as an educational and clinical reference tool. It provides a demographic-specific interpretation of an Agatston CAC score using published MESA reference values and does not independently diagnose coronary artery disease or calculate an individual's absolute ASCVD event risk.

Clinical decisions should be based on the complete clinical assessment, including cardiovascular risk factors, symptoms, laboratory findings, imaging findings, and current guideline recommendations.