It is well established, that the increased mortality in patients with acromegaly is due to cardiac diseases. Cardiomyopathy is the predominant cardiac alteration in patients with acromegaly. There are less data about coronary heart disease or coronary calcifications. Electron beam computed tomography (EBCT) is the standard imaging modality for identification of coronary artery calcifications (CAC) and can determine the extent and severity of coronary atherosclerosis. Coronary risk was evaluated by the Framingham risk score (FRS). The prospective study included 30 patients with acromegaly (mean age 53+/-14 year; 16 females, 14 males; BMI 28.1+/-3.6 kg/m (2); mean+/-SD), 12 patients had active disease (IGF-1 751+/-338 microg/L; GH 25.6+/-36.4 microg/L), 9 were well-controlled (IGF-1 157+/-58 microg/L; GH 1.8+/-1.1 microg/L) under somatostatin analogue octreotide (n=5), dopamine agonists (n=2), and the GH receptor antagonist pegvisomant (n=2; GH levels were not determined in this subgroup) and 9 were cured IGF-1 (148+/-57 microg/L; GH 0.5+/-0.2 microg/L). Increased left ventricular muscle mass index (LVMI >132 g/m (2)) was focused in 53%, hypercholesterinemia in 63%, hypertension in 43%, diabetes mellitus/impaired glucose tolerance in 27%, and smokers in 53% (pack per year 9+/-15 yr). For quantification of CAC the EBCT was used and the Agatston calcium score was determined. Results were composed to established age and sex adjusted percentile distribution of CAC. CAC was present in 53%, high CAC score (75 (th) percentile) in 37% and were categorized as cardiovascular high risk patients. FRS was related to the CAC score (p=0.008, r (2)=0.22) and the disease duration (p=0.002, r (2)=0.29). The CAC score correlated with LVMI (p=0.02, r (2)=0.17), the disease duration of acromegaly (p=0.004, r (2)=0.36), and the FRS (p=0.008, r (2)=0.22). Patients with a high CAC score had a longer disease duration of 9.6+/-4.7 versus 5.4+/-2.8 years with CAC<75 (th) percentile (p=0.02). In summary, the disease duration and consequently the accompanying metabolic disorders appear to influence the degree of CAC in patients with acromegaly. The observations underline the importance of early and sufficient treatment of acromegaly in high risk patients.