Estimate your 10-year coronary heart disease risk using the validated MESA equations, with and without CAC. Includes Coronary Age.
The MESA Risk Score was developed from the Multi-Ethnic Study of Atherosclerosis, a prospective cohort of 6,814 participants aged 45-84 who were free of clinical heart disease at baseline and followed for over 10 years. It predicts 10-year risk of coronary heart disease events including myocardial infarction, cardiac arrest, angina requiring revascularization, and CHD death.
The score incorporates age, sex, race/ethnicity, total cholesterol, HDL cholesterol, systolic blood pressure, use of blood pressure medication, lipid-lowering medication, diabetes, smoking status, family history of MI, and optionally the coronary artery calcium (CAC) score.
Including CAC in the MESA Risk Score significantly improves discrimination (C-statistic 0.80 vs. 0.75 without CAC). This was externally validated in both the Heinz Nixdorf Recall Study and the Dallas Heart Study. A zero CAC score is the strongest negative risk predictor, with a diagnostic likelihood ratio of 0.41 for CHD. Patients with CAC over 300 had 10-year event rates ranging from 13% to 26% across all demographic subgroups.
Coronary Age translates your risk into a more intuitive metric: the age at which an average healthy person would have your same level of risk. This concept was derived by Blaha et al. from the MESA study and published in the Journal of the American Heart Association in 2021. If your coronary age is significantly higher than your actual age, it suggests your cardiovascular risk factors are taking a measurable toll.
The ACC/AHA prevention guidelines define risk thresholds: low risk is below 5%, borderline is 5-7.5%, intermediate is 7.5-20%, and high risk is above 20%. These thresholds help guide decisions about statin therapy, aspirin use, and the intensity of lifestyle modifications. CAC scoring is specifically recommended by the 2018 ACC/AHA guidelines for patients at borderline or intermediate risk when the treatment decision is uncertain.
The MESA CHD Risk Score (this calculator) predicts your absolute 10-year risk of a heart event by combining your CAC with traditional risk factors. The CAC Percentile Calculator compares your calcium score to others of the same age, sex, and ethnicity. Use both for a complete picture: the percentile tells you how your calcium compares to peers, while the risk score tells you your actual probability of an event.