What the MESA score tells you
The MESA risk score is the estimated chance of a coronary heart disease event in the next 10 years: a heart attack, cardiac arrest, death from coronary disease, or a stent or bypass for angina. The calculator shows two numbers. One uses only your risk factors; the other adds your coronary artery calcium (CAC) score from a CT scan.
The gap between them is the point of the test. Risk factors describe the average person with your numbers; a calcium scan shows how much plaque has actually built up in your own arteries. A score of 0 usually moves the estimate well down, and a high score moves it up. When you have a scan, trust the number that includes it.
Calcium score by age
Calcium builds up with age, so the same score means different things at 50 and at 75. At 55, 56% of white men have a score above 0, compared with 26% of white women, and women tend to develop calcium about 10 years later than men.
Guidelines treat a score at the 75th percentile or higher for your age, sex, and race as a risk-enhancing finding. The calculator above tells you which percentile band your score falls in. See the full calcium score by age chart for every age from 45 to 84, and what is typical before 45.
What your calcium score means
The 2018 ACC/AHA cholesterol guideline uses these ranges when a calcium score is used to decide about a statin:
0
No calcified plaque detected. Near-term risk of a heart attack is very low, and many people at borderline or intermediate risk can hold off on a statin and recheck in 5–10 years.
1–99
Some plaque is present. The 2018 ACC/AHA guideline says this favors starting a statin, especially at 55 or older.
100–299
A moderate amount of plaque. At 100 or higher the guideline considers a statin reasonable regardless of the other numbers.
300 and up
Extensive plaque and a high risk of future coronary events. Clinicians usually treat cholesterol more intensively and review blood pressure and other risk factors closely.
A calcium scan is most useful when your 10-year risk is borderline or intermediate and the decision about a statin is unclear. It is usually not recommended when risk is already clearly low or clearly high. Check your starting point with the PREVENT calculator or see what your ASCVD risk score means.
A calcium score of 0
A score of 0 is the most reassuring result a calcium scan can give, and it usually pulls the MESA estimate well below the risk-factor-only number. It cannot see soft, non-calcified plaque and does not cancel out diabetes, smoking, or a strong family history. More on what a calcium score of 0 means.
MESA vs. PREVENT and ASCVD
The PREVENT and ASCVD equations estimate heart attack and stroke risk from risk factors alone, and their results map onto guideline treatment ranges. MESA estimates coronary events only, and it is built to use a calcium score. Because they measure different things, a 6% MESA result and a 6% PREVENT result are not the same.
A practical order: start with PREVENT to see where you stand, then use MESA if you have had, or are considering, a calcium scan.
Who should not use this calculator
- Anyone who has had a heart attack, stroke, stent, bypass surgery, or heart failure.
- People younger than 45 or older than 85, the ages the model was built for.
- People outside the four groups studied in MESA; results may be less accurate.
- Anyone with symptoms right now. A calcium score cannot rule out a heart attack happening today — know the warning signs and call 911.
MESA calculator: FAQ
What is the MESA risk score?
The MESA risk score estimates your 10-year chance of a coronary heart disease event: a heart attack, cardiac arrest, death from coronary disease, or a stent or bypass for angina. It was built in 2015 from the Multi-Ethnic Study of Atherosclerosis, which followed about 6,800 U.S. adults, and it is the main risk calculator that can include a coronary artery calcium (CAC) score.
How does the calcium score change my risk estimate?
The MESA calculator runs two models: one with only traditional risk factors, and one that adds the calcium score. A score of 0 usually pulls the estimate well below the risk-factor-only number, while a high score pushes it up. When you have a scan, the estimate that includes the calcium score is the more accurate one.
Why does the calculator ask for race or ethnicity?
The published 2015 MESA equations include the four groups studied in MESA (White, Black, Hispanic, and Chinese American), and calcium scores differ between these groups at the same age. MESA has since released a version without race or ethnicity; its equations have not been published yet, so this calculator uses the 2015 model.
Can a calcium score go down?
Usually not. Calcium scores tend to rise with age, and statins can even increase the score slightly as plaque stabilizes. That is why the score is used to decide whether to treat, not to track whether treatment is working. Lowering blood pressure and cholesterol still lowers your overall risk.
Is the MESA score the same as my ASCVD or PREVENT score?
No. MESA predicts coronary heart disease events only, while ASCVD and PREVENT-ASCVD scores also include stroke, so the percentages are not interchangeable. Use MESA to see what your calcium scan adds, and the PREVENT or ASCVD score for the guideline treatment ranges.
Sources and editorial notes
- McClelland RL, et al. 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in MESA. J Am Coll Cardiol. 2015;66(15):1643–1653.
- McClelland RL, et al. Distribution of Coronary Artery Calcium by Race, Gender, and Age: Results from MESA. Circulation. 2006;113(1):30–37.
- Grundy SM, et al. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082–e1143.
- MESA — Risk Score and Coronary Age Calculator (official)
- MESA — CAC Reference Calculator (official)
By HeartRiskCalc Editorial Team · Published · Updated . Uses the published 2015 MESA coefficients and was checked against the official MESA calculator: the estimate with a calcium score matches it; the risk-factor-only estimate can read about 1% lower (for example 6.5% vs. 6.6%) because the published coefficients are rounded. Calcium percentiles are from the MESA CAC reference calculator. Not affiliated with MESA or the NHLBI. Not independently reviewed by a clinician. Educational information only.