Coronary Artery Calcium (CAC) Percentile Ranking: Explanation and Clinical Context CAC percentile ranking provides an age- and sex-specific comparison of an individual's coronary artery calcium score to a reference population, as defined in the Multi-Ethnic Study of Atherosclerosis (MESA).
It helps to stratify atherosclerotic cardiovascular disease (ASCVD) risk beyond traditional risk factors. A higher percentile indicates a higher burden of coronary calcification relative to peers, suggesting elevated risk of future coronary events.
For example, a CAC score of 0 generally corresponds to very low risk (<25th percentile), whereas a CAC score above the 75th percentile indicates substantially higher risk.
Clinicians can use CAC percentiles to guide preventive strategies such as statin therapy, lifestyle modifications, and monitoring intensity.
Reference:
Goff DC, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. J Am Coll Cardiol. 2014;63:2935–2959. doi:10.1016/j.jacc.2013.11.005
Budoff MJ, et al. Coronary Artery Calcium and Cardiovascular Risk in MESA. Circulation. 2007;115:402–409. doi:10.1161/CIRCULATIONAHA.106.675401