Cardiac Imaging Scores (ECHO, CT, MRI)

MESA Coronary Artery Calcium Risk and Coronary Age Calculator

Clinical calculation support · Verify results before clinical use

Patient risk profile

Enter baseline clinical characteristics and the coronary artery calcium score.

MESA · 10-YEAR CHD

Demographics and imaging

Derivation cohort range: 45–84 years.
Enter the total Agatston score; zero is valid.
Use only the categories represented in the derivation cohort.

Clinical risk factors

Parent, sibling, or child.

Calculated results

10-year CHD risk · with CAC

—
MESA risk equation including log(CAC + 1).

10-year CHD risk · without CAC

—
MESA risk equation using traditional risk factors only.

Risk difference after CAC

—
Absolute percentage-point difference (with CAC minus without CAC).

Coronary age

Not available
The published healthy-comparator coefficients required for this demographic subgroup are not fully specified in the worked equation available for independent implementation.
Important: The MESA endpoint is coronary heart disease (including myocardial infarction, resuscitated cardiac arrest, angina-driven revascularization, and CHD death). It is not a general ASCVD or stroke risk estimate.

About the MESA CHD Risk Score

The MESA model estimates 10-year coronary heart disease risk in adults without clinical cardiovascular disease at baseline. The CAC-inclusive model combines conventional risk factors with the natural logarithm of CAC + 1.

Model coefficients

PredictorWithout CAC βWith CAC β
Age (years)0.04550.0172
Male sex0.74960.4079
Chinese American−0.5055−0.3475
African American−0.21110.0353
Hispanic−0.1900−0.0222
Diabetes0.51680.3892
Current smoker0.47320.3717
Total cholesterol (mg/dL)0.00530.0043
HDL cholesterol (mg/dL)−0.0140−0.0114
Lipid-lowering medication0.24730.1206
SBP (mmHg)0.00850.0066
Antihypertensive medication0.33810.2278
Family history of MI0.45220.3239
ln(CAC + 1)—0.2743

Risk = 1 − S(10)exp(A); baseline survival S(10) is 0.99963 without CAC and 0.99833 with CAC. A is the sum of the applicable β × predictor terms.

CAC burden categories

Agatston scoreDescriptive burden
0No detectable coronary calcium
1–99Mild CAC burden
100–299Moderate CAC burden
≥300High CAC burden

Coronary age methodology

Coronary age is a risk-equivalent age: the age at which an average healthy comparator would have the same estimated 10-year CHD risk as the individual. It is derived by equating the patient's MESA risk with a comparator risk equation and solving for age.

The 2021 publication describes age- and sex-specific comparator SBP and total cholesterol, sex-specific HDL values (45 mg/dL for men and 55 mg/dL for women), no diabetes or current smoking, and background prevalence of medication use and family history.

Implementation safeguard: This release does not output a numerical coronary age because the complete comparator regression coefficients and background prevalences for all sex-specific groups are not provided in the worked example. The example equation for a White man (A = 0.0455 × age + 2.45) is not treated as a universal equation. This prevents an unsupported age-equivalence estimate.

References

McClelland RL, et al. (2015). 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in MESA With Validation in HNR and DHS. J Am Coll Cardiol. 66(15):1643–1653. doi:10.1016/j.jacc.2015.08.035
Blaha MJ, et al. (2021). Derivation of a Coronary Age Calculator Using Traditional Risk Factors and Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 10(6):e019351. doi:10.1161/JAHA.120.019351
MESA-NHLBI. Official MESA Risk Score and Coronary Age Calculator. Official calculator.
Clinical disclaimer: This calculator is intended to support risk communication and clinical assessment, not to replace clinical judgment. The original MESA model was derived in a US cohort of adults aged 45–84 years without clinical cardiovascular disease at baseline, with White, Chinese American, African American, and Hispanic participants. Estimates may not be calibrated for populations not represented in the derivation cohort, including Indonesian populations. Do not interpret the estimate as an individual diagnosis or as a direct estimate of total ASCVD risk.
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