Agatston Score of 5.7: Interpretation and Management
An Agatston score of 5.7 indicates minimal coronary artery calcification (CAC) representing very low to mildly increased cardiovascular risk, and should prompt aggressive lifestyle modification with consideration for statin therapy based on the presence of additional risk-enhancing factors and shared decision-making. 1
Risk Stratification
Your Agatston score of 5.7 falls into the 1-100 range, which correlates with very low to mildly increased coronary heart disease risk 1:
- Agatston 0: Very low risk
- Agatston 1-100: Mildly increased risk (your score falls here)
- Agatston 101-300: Moderately increased risk
- Agatston >300: Moderately to severely increased risk
Clinical Significance
The presence of any detectable calcium (score >0) confirms atherosclerotic plaque in your coronary arteries, even at this low level 1, 2. While a score of 5.7 indicates minimal calcification, it definitively rules out a calcium score of zero, which would have provided the strongest reassurance 3, 4.
Management Recommendations
Immediate Actions
Initiate intensive lifestyle modifications immediately 1:
- Mediterranean or DASH diet pattern
- Minimum 150 minutes/week moderate-intensity aerobic exercise
- Weight reduction if BMI ≥25 kg/m²
- Smoking cessation if applicable
- Blood pressure control to <130/80 mmHg
- Optimize glycemic control if diabetic
Statin Therapy Decision
The decision to start statin therapy depends on your 10-year ASCVD risk and presence of risk-enhancing factors 1:
If your 10-year ASCVD risk is ≥7.5%:
- A CAC score of 1-99 (which includes your 5.7) favors initiating statin therapy, especially if you are ≥55 years old 1
- Start moderate-intensity statin (targeting 30-49% LDL-C reduction) 1
If your 10-year ASCVD risk is 5-7.4% (borderline):
- Evaluate for risk-enhancing factors that would favor statin initiation 1:
- Family history of premature ASCVD
- LDL-C persistently ≥160 mg/dL
- Metabolic syndrome
- Chronic kidney disease
- Chronic inflammatory conditions (rheumatoid arthritis, psoriasis, HIV)
- South Asian ethnicity
- Triglycerides persistently ≥175 mg/dL
- High-sensitivity CRP ≥2.0 mg/L
- Lipoprotein(a) ≥50 mg/dL
If your 10-year ASCVD risk is <5% (low risk):
- Statin therapy may be deferred, but aggressive lifestyle modification remains essential 1
- Your CAC score >0 still indicates atherosclerosis requiring risk factor management 1, 3
Follow-Up Strategy
Repeat lipid panel 4-12 weeks after any intervention (lifestyle changes or statin initiation) to assess response 1
Annual cardiovascular risk assessment including:
- Blood pressure monitoring
- Lipid panel
- Fasting glucose or HbA1c
- Assessment of adherence to lifestyle modifications 1
CAC score progression monitoring is NOT routinely recommended for clinical decision-making, as treatment decisions should be based on initial score and risk factors 3
Critical Caveats
A low CAC score does not exclude non-calcified plaque or acute coronary syndrome risk 1, 2. Symptoms of chest pain, dyspnea, or other cardiac symptoms require immediate evaluation regardless of CAC score.
Your score confirms you cannot be categorized as "zero calcium," which would have provided the strongest negative predictive value for obstructive coronary disease 3, 4
The Agatston score was developed for gated cardiac CT scans; if your score was obtained from a non-gated chest CT, it correlates well but may have slightly different precision 1