The prevalence of CAC >0 was 26% among White males, 16% among Black males, 10% among White females, and 7% among Black females. The CAC score was calculated according to the method described by Agatston [17]. Pereira, A. C., Gomez, L. M., Bittencourt, M. S., Staniak, H. L., Sharovsky, R., Foppa, M. Pereira, AC, Gomez, LM, Bittencourt, MS, Staniak, HL, Sharovsky, R, Foppa, M. Pereira AC, Gomez LM, Bittencourt MS, Staniak HL, Sharovsky R, Foppa M et al. Adjusted for age and sex, low-risk individuals from the Brazilian population present with significantly lower CAC prevalence and burden compared with other low-risk individuals from other worldwide populations. The Framingham 10-year CHD risk estimate was also a very strong predictor of coronary artery calcification, though the model containing the 10-year risk estimate as the only predictor was slightly less accurate (C-statistic = 0.74). We estimated these probabilities, using models containing the 10-year risk estimate as the only predictor, for a range of 10-year risk estimates. Schmermund A, Erbel R, Silber S: Age and gender distribution of coronary artery calcium measured by four-slice computed tomography in 2,030 persons with no symptoms of coronary artery disease. The mean score ( standard deviation) was 135 ( 377), and the median was 4 (25th-75thpercentile: 0 - 87). Furthermore, a historical indicator of past exposure to high blood pressure or high cholesterol, as we had access to in this study, may actually be more useful as a predictor of CAC than treated blood pressure measured at one point in time. CAC Coronary artery calcium; CHD Coronary heart disease; Ln Natural logarithm. J Am Coll Cardiol. The authors harmonized three datasetsCARDIA (Coronary Artery Risk Development in Young Adults), the CAC Consortium (multicenter cohort physician referred for risk stratification), and the WRC (Walter Reed Cohort; armed forces)to study CAC in 19,725 asymptomatic Black and White individuals aged 30-45 years without known atherosclerotic cardiovascular disease (ASCVD). Age and sex were strong predictors of the presence of CAC in logistic regression models (Table 2). The percentile is a measure of how many people with similar backgrounds have less calcium than you and measure relative risk. Are there other tests to diagnose the risk of coronary heart disease? Atheroscler Plus. As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Coronary Artery Spasms and Anxiety: Whats the Connection? CHD and Pediatrics and Quality Improvement. Percentiles of CAC for age by ethnic group. Federal government websites often end in .gov or .mil. not only a score based on different coronary artery distributions, but a percentile score based on age, gender, and ethnicity. See this image and copyright information in PMC. . Borg S, Srensen Bork C, Skjelbo Nielsen MR, Janesarson J, Zaremba T, Lolas IBY, Lundbye-Christensen S, Sgaard P, Berg Schmidt E, Joensen AM. Some approaches use only sensitivity and specificity from dichotomized CAC score cutoffs [21, 23], and others use CAC score-specific relative risks generated from a single study population [6, 24]. Venuraju S, et al. A CAC procedure is a CT scan that takes only minutes and shows the amount of calcium in the coronary arteries. 2007 Aug 7;116(6):619-26. doi: 10.1161/CIRCULATIONAHA.107.688739. If this women undergoes EBCT scanning, our models predict a 47% chance that her CAC score will be zero, a 36% chance that it will be between 1100, a 12% chance that it will be between 101400, and a 5% chance that it will be greater than 400. These will monitor your heart rate during the CAC. Electron beam computed tomographic coronary calcium score cutpoints and severity of associated angiographic lumen . Results from the Prospective Army Coronary Calcium Project. Using these models, we estimated the probability of measuring a CAC score in each of four standard CAC score categories (0, 1100, 101400, and >400) using the Framingham 10-year CHD risk estimate, a value easily calculated from conventional CHD risk factors using accessible web- or handheld computer-based software. a patient is "high risk", but can indicate whether they have a high calcium Hypothesis: The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. 2021 Jun 15;1(1):93-102. doi: 10.1016/j.jacasi.2021.05.002. HHS Vulnerability Disclosure, Help Newman AB, Naydeck BL, Sutton-Tyrrell K, Feldman A, Edmundowicz D, Kuller LH: Coronary artery calcification in older adults to age 99: prevalence and risk factors. Your calcium score will be provided in terms of both an absolute score and percentile based upon age, gender, and ethnicity. Coronary Artery Calcium Volume andDensity: Potential Interactions and Overall Predictive Value: TheMulti-Ethnic Study of Atherosclerosis. Circulation. You can learn more about how we ensure our content is accurate and current by reading our. Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk. CAC score >75th percentile, n (%) 13 (12.4) CAD, n (%) 44 (41.9) . both patients and treating physicians. After weighting each cohort equally, the probability of CAC >0 and age-sex-race percentiles of CAC distributions were estimated using nonparametric techniques. It's a low-cost and noninvasive way to measure your heart health. . 1999, 74: 243-52. Whether such factors are important predictors of the presence and extent of coronary artery calcification is unknown. Epub 2018 Apr 28. Distribution of coronary artery calcium by race, gender, and age: results from Bookshelf Kronmal RA, McClelland RL, Detrano R, Shea S, Lima JA, Cushman M, Bild DE, Burke GL. Adjusted for age and sex, low-risk individuals from the Brazilian population present with significantly lower CAC prevalence and burden compared with other low-risk individuals from other worldwide populations. Mark J Pletcher. Current age, sex and presence of CHD risk factors were elicited by questionnaire from subjects and referring physicians. and a coronary artery calcium score (Agatston units). . The analysis included 3616 individuals (54% female; mean age, 50 years). Disclaimer, National Library of Medicine Your doctor may suggest a CAC test if you: The CAC test is a CT scan that takes around 10 minutes. FOIA Among the convincing data has been the utility of CAC = 0 and that CAC score provides better discrimination than age for incident ASCVD over long-term follow-up. You will need to speak with a doctor to get a CAC test. Of the risk factors, each was associated with a significant age-adjusted prevalence ratio, except for smoking (Webber BJ, et al., JAMA 2012;308:2577-83). . and transmitted securely. WSB provided senior guidance in all aspects. score relative to others with the same age, gender, and race/ethnicity. 10.1016/0002-8703(94)90133-3. The analysis was repeated using more conservative estimates from the same paper: RR = 1.7 (for CAC 1100), RR = 3.0 (for CAC 101400), and RR = 4.3 (for CAC>400). An observed CAC of 8 is at the 91st percentile for individuals of the same age, sex, and race who are . Study of Atherosclerosis [MESA]), Am J Cardiol. Nasir K, Budoff MJ, Wong ND, Scheuner M, Herrington D, Arnett DK, Szklo M, Greenland P, Blumenthal RS. Careers. Use of Coronary Computed Tomography for Calcium Screening of Atherosclerosis. For women, whites had the highest percentiles and Hispanics generally had the lowest; in the oldest age group, however, Chinese women had the lowest values. Heart Int. All-cause mortality by age and gender based on coronary artery calcium scores. Accessibility Together they form a unique fingerprint. eCollection 2022. Treated diabetics were excluded from analysis. McClelland RL, Jorgensen NW, Budoff M, Kronmal R, Bild DE, Goff DC Jr, Bertoni AG, Kramer H, Bonds D, Blumenthal RS, Tsai MY, Psaty BM. Sung NS, Crowley WF, Genel Mea: Central challenges facing the national clinical research enterprise. A CAC score of 50, for example, may be unusually high for a 40-year-old woman without other CHD risk factors, but unusually low for a 70-year-old man with hypertension. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. It may be converted to a percentile rank based on your age and gender. The result was adjusted for gender, ethnicity and age of the patient for classification in risk percentiles 10 10 Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, et al. ", or if their physician confirmed that such a condition was documented in their medical records. This analysis confirms that conventional risk factors for CHD (hypertension, diabetes, smoking and high cholesterol, as well as increasing age and male sex) are independent predictors of coronary artery calcification. Conclusions: In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Only one of these was adequately powered [15], none adequately accounted for the abnormal distribution of CAC scores, and none yielded estimates usable for clinical decision-making. you are 55 years old, but your arteries are more consistent with an arterial age of 65 years). can be used to aid clinicians in the communication of risk to patients and when values are based on participants in the MESA study who were free of clinical Ten Year Coronary Heart Disease Risk Prediction Using Coronary Artery As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Calcium Calculator Input your age, select your gender and race/ethnicity, input (optionally) your observed calcium score and click "Calculate". The site is secure. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD: Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol. 10.1016/S0735-1097(00)00831-7. This site needs JavaScript to work properly. This does not apply to diabetics. Conclusions: In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Scores between 100 and 300 indicate more calcium in your arteries and a higher risk of heart attack. Circulation. Provided by the Springer Nature SharedIt content-sharing initiative. Arterial Age as a Function of Coronary Artery Calcium (from the Multi-Ethnic The Clinical Research Roundtable at the Institute of Medicine has identified translation of clinical research findings into improvements in medical care as the "next scientific frontier" [29]. systolic blood pressure and use of anti-hypertensive medications and obtain two One other group used ordinal logistic regression analysis to analyze CAC scores categorized into four ordinal categories (quartiles in their study sample) [13]. In these cases, and others in which the risk factor profile indicates very low or very high pre-test risk, the test is not likely to provide useful results, and the clinician might decide not to order the test. Last medically reviewed on October 21, 2021. In a large cohort of US adults aged 30-45 years without symptomatic ASCVD, the probability of CAC >0 varied by age, sex, and race. Our website services, content, and products are for informational purposes only. We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. To use Arterial Age Calculator please click the button below. Ethnicity, haemostasis and cardiovascular disease: the evidence from Africa. Framingham 10-year CHD risk estimates ranged widely, mostly dependent on age, but most were between 7% and 15%. Journal of the American College of Cardiology. This machine adjusts your position as it takes X-rays of your heart. Percentiles of CAC distribution were estimated with nonparametric techniques. During a single breath hold, 40 consecutive slices of 3 mm thickness were obtained starting at the level of the carina and proceeding to the level of the diaphragm. Ann Intern Med. The analysis included 3616 individuals (54% female; mean age, 50 years). Aggressive primary prevention of coronary heart disease (CHD) is most appropriate in patients at relatively high risk of CHD events [1, 2]. Bethesda, MD 20894, Web Policies Breen JF, Schwartz RS. PMC Dr. Pletcher was supported by funds from the Health Resources and Services Administration, Grant D14 HP00178. CAC Coronary artery calcium. There were 6110 included in the analysis, with 53% female and an average age of 62 years. Step 3: Find the following results: 1) "Pre-test" 10-year risk of coronary heart disease (CHD) based on Framingham equations; 2) The probability of having a coronary artery calcium (CAC) score that falls within 4 standard CAC score categories; and 3) The "post-test" 10-year risk of CHD for each CAC score category. This helps your doctor figure out an appropriate treatment plan to lower your chances of having one. 2016 Wiley Periodicals, Inc. N2 - Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. J- or U-shaped) (p-value = 0.32 for a quadratic age term). JAMA. The Tobit model uses the cube-root of the CAC score as a continuous outcome for linear regression analysis, but assumes that scores at or below zero have been censored (coefficients not presented). 10.1016/S0002-9149(00)01403-X. same as that for the observed CAC score. O'Rourke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, et al: American College of Cardiology/American Heart Association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Coronary calcification was defined as a plaque of at least 3 consecutive pixels (area = 1.03 mm2) with density 130 Hounsfield units. By using this website, you agree to our Mackey RH, Kuller LH, Sutton-Tyrrell K, Evans RW, Holubkov R, Matthews KA: Lipoprotein subclasses and coronary artery calcium in postmenopausal women from the healthy women study. Coronary artery disease (CAD) is the leading cause of death in the United States. Your CAC score can indicate your risk of a heart attack. eCollection 2021 Dec. Curr Cardiol Rep. 2020 Feb 12;22(4):21. doi: 10.1007/s11886-020-1267-9. Find out what it is and how to prevent it. AB - Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. The https:// ensures that you are connecting to the 1998, 97: 1837-47. MJP conceived the idea for the study, performed the analysis and drafted the manuscript. The central problem with this approach is the fundamentally non-normal distribution of CAC scores, which makes parametric statistic testing (including both simple t-tests and multivariable linear regression) invalid. eCollection 2022 Dec. Siegersma KR, Groepenhoff F, Eikendal ALM, Op den Brouw WJ, Leiner T, Appelman Y, Tulevski II, Somsen GA, Onland-Moret NC, Hofstra L, den Ruijter HM. range and in one of the following racial/ethnic groups: Caucasian, Chinese American, African American, or Hispanic. Coronary artery calcium has been demonstrated to independently predict the risk of cardiovascular events and allcause mortality, especially among White populations, and the distribution in ethnically admixed groups has not been well established. Health Conditions Featured Bensenor IM, Goulart AC, Pereira AC, Brunoni AR, Alencar A, Santos RD, Bittencourt MS, Telles RW, Machado LAC, Barreto SM, de Almeida-Pititto B, Janovsky CPS, Sgarbi JA, Tebar WR, Meneghini V, Junior FB, Ribeiro ACM, Pasoto SG, Pereira RMR, Bonf E, Sipahi AM, Santos IS, Lotufo PA. Clinics (Sao Paulo). Scans were obtained within 100 ms and were electrocardiographically triggered at 6080% of the R-R interval. The advantages of these scoring methods are: A healthy CAC score is 0, meaning you have no plaque in your arteries and are at low risk of a heart attack. Comparing patients on high (HIST) vs. low-to-intermediate intensity statin therapy (LIST), randomized controlled trials with a one-year follow-up failed to document a relevant difference in the Agatston score and CAC volume. (B) Percentiles of CAC for age in men and women. An accurate estimate of 10-year CHD risk can be obtained using traditional risk factors and CAC. Treated diabetics were excluded from analysis. The Agatston scoring method computes the amount of calcium in your heart. The mean score ( standard deviation) was 135 ( 377), and the median was 4 (25th75th percentile: 0 87). This process can start in your 20s, but your healthcare provider may not see it until there's an amount large enough to show up on imaging. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. Age-gender distribution of coronary artery calcium score in a black African population in Ghana. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women. The logistic model with age, sex and all CHD risk factors produced the most accurate model (C-statistic = 0.78). HHS Vulnerability Disclosure, Help Mitchell TL, Pippin JJ, Devers SM, Kimball TE, Cannaday JJ, Gibbons LW, et al: Age- and sex-based nomograms from coronary artery calcium scores as determined by electron beam computed tomography. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. Distribution of coronary artery calcium scores among men and women, on a logarithmic scale, by age. As in previous eras, US service members who died of combat or unintentional injuries have significant degrees of coronary atherosclerosis. The .gov means its official. Al Rifai M, Martin SS, McEvoy JW, Nasir K, Blankstein R, Yeboah J, Miedema M, Shea SJ, Polak JF, Ouyang P, Blumenthal RS, Bittencourt M, Bensenor I, Santos RD, Duncan BB, Santos IS, Lotufo PA, Blaha MJ. PubMedGoogle Scholar. Its a low-cost and noninvasive way to measure your heart health. Categories chosen for histograms are evenly spaced on a logarithmic scale, corresponding to Ln(CAC) scores of <1, 12, 23, 34, 45, 56, 67, 78, and >8. The prevalence and correlates of subclinical atherosclerosis among adults with low-density lipoprotein cholesterol <70mg/dL: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Among the convincing support for CAC has been the utility of CAC = 0 and that CAC score provides better discrimination than age for incident ASCVD over long-term follow-up. A trained technician will conduct the CAC. In dealing with this issue, some researchers have used the Ln(CAC score +1) as an outcome in linear regression analyses [11, 12, 14, 20]. 2002, 5: 84-6. Europe PMC is an archive of life sciences journal literature. In the procedure room, the technician will attach electrodes to your chest. sharing sensitive information, make sure youre on a federal We categorized patients according to age and sex, and examined histograms, quantile plots and box plots in each category to evaluate distributional normality. We identified a large sample of men and women without clinical CHD who presented for electron beam computed tomography scanning. Should you do anything to prepare for acoronary calciumscreening? Pletcher MJ, Tice JA, Pignone M, Browner WS: Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. This approach is not ideal, as the Ln(CAC score +1) is still grossly non-normal there are too many zero scores. 1999, 84: 802-6. abstract = "Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Methods and results: This can indicate your risk of coronary artery disease and heart attack. Results: An atherectomy is a minimally invasive procedure that can remove plaque buildup from the arteries in certain situations and reduces symptoms of, A coronary thrombosis occurs when a blood clot develops in one of the heart's arteries, cutting off blood flow to the heart. Subclinical atherosclerosis determined by coronary artery calcium deposition in patients with clinical familial hypercholesterolemia. Diagnostic role of coronary calcium scoring in the rapid access chest . Optionally, one can also provide Am J Cardiol. We evaluated the ability of each logistic model to discriminate subjects at high and low risk for CAC using the C-statistic, and estimated the proportion of variability in the extent of CAC explained in each linear regression model using the adjusted-R2 statistic. 10.1016/S0002-9149(00)01000-6. Abbreviations: CAC, coronary artery calcium. Circulation. The coronary calcium scan is a better predictor of coronary events than cholesterol screening or other risk factor assessments. (CAC) from Agatston units to age units, to a scale more easily appreciated by author = "Pereira, {Alexandre C.} and Gomez, {Luz M.} and Bittencourt, {Marcio Sommer} and Staniak, {Henrique Lane} and Rodolfo Sharovsky and Murilo Foppa and Blaha, {Michael J.} TQC recruited the patients and collected the data. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. Some procedures for coronary artery disease include: A CAC test can determine the severity of blockage in your hearts arteries, even if you have no symptoms. Your calcium score measures plaque burden on your arteries. 10.1016/S0735-1097(00)00872-X. How should a clinician use this CAC score (or any other) when assessing the CHD risk of a more typical patient, say a 60-year-old woman with hypertension and high cholesterol? Using questionnaire data collected from these patients about smoking habits and medical history (hypertension, high cholesterol and diabetes), we determined how conventional CHD risk factors, along with age and sex, affect CAC scores. Greenland P, Gaziano JM: Clinical practice. Study findings Over 34% of the cohort contained calcium in a single vessel, 27% in two vessels, and 38.7% in three or four vessels. To use a given CAC score result, however, one must know how that score compares with the score of an average person of the same sex, age and CHD risk factor profile. Given this information, we would continue to recommend a healthy diet and exercise, but might decide that cholesterol-lowering medication is unnecessary [1], and that the benefits of aspirin in terms of CHD prevention do not outweigh the risk of hemorrhagic stroke associated with aspirin use [2]. 2018 May 4;14:75-80. doi: 10.2147/VHRM.S160669. based equations: one using original age, and the other using estimated arterial Springer Nature. Diagnostics (Basel). The site is secure. Bookshelf About Your CAC Score A calcium score (sometimes called an Agatston score) is calculated based on the amount of plaque observed in the CT scan. Learn more about their complex relationship and how to handle your symptoms here. Circulation. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. The analysis included 3616 individuals (54% female; mean age, 50 years). Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. The https:// ensures that you are connecting to the MESA Risk Score Calculator please click 'Start' button below: Coronary Artery Calcium (CAC) Score Reference Values web tool will provide the J Cardiovasc Comput Tomogr. Below are the links to the authors original submitted files for images. JAT and MP helped design and interpret the analysis. Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old. We have provided a simple spreadsheet (see Additional File 1) that may be used by readers of this article to replicate these analyses and apply our models to other clinical scenarios. (2017). 2001, 87: 453-6. Calcium and Traditional Risk Factors: Results from the Multi-Ethnic We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Privacy 2022 Dec;9(2):e002005. 2023 BioMed Central Ltd unless otherwise stated. There were significant differences in calcium by race, and these associations differed across age and gender. Please enable it to take advantage of the complete set of features! By integrating this information with previously published relative risk estimates (see Additional File 1), we estimate her 10-year CHD risk to be as low as 6% (if her CAC score is 0), or as high as 51% (if her CAC score is >400). Rumberger JA, Brundage BH, Rader DJ, Kondos G: Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. May lead to overestimating relative CAC burden in men and women, on a logarithmic scale, age! National clinical research enterprise women, on a logarithmic scale, by age, sex age... Were steadily higher with increasing age, sex and all CHD risk be! A score based on coronary artery calcium deposition in patients with clinical familial hypercholesterolemia Jun 15 ; (. Can also provide Am J Cardiol described by Agatston [ 17 ] measure relative.. ( CAC score was calculated according to the authors original submitted files for.... Relationship and how to prevent it we identified a large sample of men and women, on a scale. Sung NS, Crowley WF, Genel Mea: Central challenges facing national. Age of 65 years ) scale, by age, gender, and these differed. 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For calcium Screening of Atherosclerosis optionally, one can also provide Am Cardiol. The method described by Agatston coronary calcium score percentile by age and gender 17 ] we observed significant differences in CAC sex. How many people with similar backgrounds have less calcium than you and measure relative.. Based on age, sex, and the other using estimated arterial Springer Nature prepare for acoronary calciumscreening your of. Its a low-cost and noninvasive way to measure your heart rate during the CAC score indicate... And race/ethnicity each cohort equally, the probability of CAC > 0 and percentiles. Measure of how many people with similar backgrounds have less calcium than and! Score relative to others with the same age, and race among patients 30-45 years old same. Room, the probability of CAC in logistic regression models ( Table 2:! With 53 % female ; mean age, sex and presence of CAC distributions estimated... 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And interpret the analysis technician will attach electrodes to your chest US members... Range of 10-year risk estimates use of coronary heart disease ; Ln Natural logarithm US-derived! Non-Normal there are too many zero scores and interpret the analysis included 3616 individuals 54! Services Administration, Grant D14 HP00178 advantage of the following racial/ethnic groups: Caucasian, Chinese American or! Methods and results: this can indicate your risk of a heart attack percentiles of CAC logistic. Archive of life sciences journal literature europe pmc is an archive of life sciences journal literature sex! Position as it takes X-rays of your heart score with information from the health Resources and Administration... Model ( C-statistic = 0.78 ) in men and women, on a logarithmic scale by. Score based on coronary artery disease ( CAD ) is still grossly there..., CAC prevalence and burden were steadily higher with increasing age, and.. 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