1 Age and sex
The prevalence of coronary calcium rises significantly with age. Women generally have an incidence of CAC similar to men who are a decade younger; this gender gap in prevalence disappears by age 70.
2 Ethnicity
When adjusted for age and sex, Caucasian populations tend to have the highest average coronary calcium scores; Black populations tend to have the lowest.
3 Renal failure / hemodialysis
Patients with chronic kidney disease — and especially those on hemodialysis — have a much higher incidence and faster progression of CAC.
Important: in renal failure, calcium can deposit in the tunica media (medial wall) of the vessel, independent of the typical intimal atherosclerosis seen in the general population. The total Agatston number doesn’t distinguish the two patterns — interpret the score in context.
4 Diabetics & metabolic syndrome
These patients carry a higher incidence and absolute progression rate of coronary calcium compared to the general population — and a non-zero score should be acted on aggressively, particularly when paired with elevated LDL or hypertension.