Although several studies have demonstrated the association between coronary artery calcification (CAC) and coronary artery disease events, the underlying mechanism has not been fully elucidated. Furthermore, extensive CAC still remains a poorly understood phenomenon. The objective of this study is to determine the clinical characteristics and differences between 831 asymptomatic individuals with very high CAC scores (CACS ≥ 1000) and 497 asymptomatic individuals with CAC scores of 400 to 999. Individuals with CACS ≥ 1000 were more likely to have hypertension ([HTN]; P =. 0004), hypercholesterolemia (P =. 0001), diabetes mellitus ([DM] P =.005), and high body mass index ([BMI]; P =.03) compared with individuals with CACS = 400-999. On multivariable analysis, age (P <. 0001) and BMI (P =. 01) were found to be significant risk factors for the presence of very high CAC. While for males, age (P <. 0001), hypercholesterolemia (P =. 001), DM (P =. 002), and obesity (P =. 003) were independent risk factors; in females only HTN (P =.04) was independent risk factor.