Instalab ResearchThe CAC score is expressed in Agatston units, where a score of 0 indicates no detectable calcification, and progressively higher scores indicate greater plaque burden. In general, scores are grouped as follows:
| CAC Score | Plaque Burden |
|---|---|
| 0 | No plaque |
| 1–99 | Mild plaque |
| 100–399 | Moderate plaque |
| 400 or above | Extensive plaque |
Since plaque calcification is a hallmark of atherosclerosis, the score reflects the cumulative effect of risk factors such as high cholesterol, hypertension, smoking, diabetes, and genetic predisposition. For a 60-year-old, the score can be thought of as a biological age marker of the heart and arteries. A CAC of 0 suggests arteries that are aging very gracefully, while a high CAC places someone at elevated risk for cardiovascular events and premature death.
The question of averages is critical because it grounds the discussion in real-world data. Studies across diverse populations have shown that the average CAC score rises steadily with age. In a Brazilian cohort of over 2,200 asymptomatic men, the median CAC score for those aged 60 to 64 was significantly higher than in younger groups, with the 50th percentile falling in the range of approximately 100 Agatston units.
More recent data from a Pakistani center showed that individuals with severe CAC scores had a mean age of 62, supporting the observation that by the early 60s, many patients move into the moderate-to-severe range. In U.S. and European cohort studies, median CAC scores around age 60 often cluster between 75 and 150, depending on sex and ethnicity.
Thus, while variability is wide, the “average” 60-year-old tends to fall around a CAC score of 100, meaning many individuals already show moderate calcification by this age.
Multiple large-scale studies confirm that CAC scoring is strongly predictive of both cardiovascular and all-cause mortality. In one of the largest studies of over 35,000 patients, mortality increased steadily with each higher CAC category, even in older populations. Importantly, survival remained strikingly high in those with a score of 0, regardless of age. A 70-year-old with a CAC of 0 had better survival than peers with higher scores, underscoring the protective signal of a zero score.
Another pooled analysis of U.S. and European cohorts found that CAC was more predictive of coronary heart disease events than age itself in older adults. In fact, when age was removed from traditional risk models and replaced with CAC, predictive accuracy improved significantly. For individuals over 60, the CAC score often did a better job than chronological age at distinguishing who would and would not develop heart disease.
One of the most striking findings in calcium score research is the protective effect of a score of 0. This phenomenon has been referred to as a “warranty period,” meaning a duration of time in which the risk of death is very low. In a large study of nearly 50,000 adults, those with a CAC of 0 had a markedly longer warranty period compared to those with detectable calcium, even when traditional risk factors such as diabetes or smoking were present. In practice, this means that a 60-year-old with a CAC of 0 may enjoy a decade or more of very low risk for cardiovascular death.
At the opposite end of the spectrum, high CAC scores are powerful indicators of shortened longevity. In elderly cohorts, CAC values above 400 were associated with a sharp decline in survival. For instance, an 80-year-old man with a CAC over 400 had less than a 20% survival rate over the study period, compared to nearly 90% survival in younger men with the same score. These differences reveal that calcium burden accelerates risk disproportionately as people age.
Traditional cardiovascular risk models, such as the Framingham Risk Score, incorporate age, cholesterol levels, blood pressure, and smoking history. While these models provide useful guidance, they often fail to capture the full picture in older adults, where the prevalence of risk factors is high across the board. CAC provides a direct visualization of arterial disease burden, offering clarity where conventional risk scoring may overestimate or underestimate risk. Studies consistently show that CAC adds incremental predictive value above these traditional measures, improving risk reclassification in up to 40% of older adults.
For someone at age 60, CAC scoring carries particular importance. This age represents a transitional period where cardiovascular risk begins to rise sharply, yet life expectancy remains substantial. Research indicates that CAC can stratify 60-year-olds into markedly different risk categories: those with a score of 0 enjoy survival rates comparable to much younger individuals, while those with high scores face mortality rates resembling people a decade or two older. Thus, the CAC score serves as a highly personalized indicator of biological versus chronological cardiovascular aging.
For a 60-year-old patient, a CAC scan can guide both lifestyle and medical decisions. A score of 0 may support a conservative management approach, focusing on diet, exercise, and modest medication use. Conversely, a high score may justify aggressive prevention, including statins, blood pressure control, and lifestyle intensification. In this sense, the calcium score is not just a longevity predictor but also a roadmap for targeted prevention.
Still, it is not a perfect tool. CAC reflects calcified plaque but not soft, non-calcified plaque, which can also rupture and cause events. It also does not account for non-cardiovascular causes of death. In fact, for those with a CAC of 0, cancer often emerges as the leading cause of death in later life. These nuances remind us that while CAC powerfully predicts heart-related outcomes, longevity overall depends on a broader interplay of health factors.
Ultimately, the average calcium score for a 60-year-old hovers near 100 Agatston units, which represents moderate plaque burden. Yet the true predictive power lies not in the average but in the extremes: the reassuring protection of a score of 0 and the ominous risk of very high scores. For the individual sitting in the doctor’s office at age 60, this number can be life-changing, shaping both expectations for the future and the urgency of prevention today.
