Statins and coronary calcium score
Do statins increase coronary calcium scores over time, and does a higher calcium score indicate greater cardiovascular risk?
Statins can be associated with an increase in coronary artery calcium (CAC) on serial scans. This rise reflects plaque stabilization: statins reduce the soft lipid core and promote calcification, making plaques harder and less likely to rupture. The increase in CAC does not mean the medication is harming the arteries, and it should not lead to stopping therapy. Large trials show that despite higher CAC progression, statin‑treated patients have fewer heart attacks and strokes. Independently, a higher CAC score correlates with higher overall cardiovascular risk (0 = low, 1‑99 = mild, 100‑399 = moderate, ≥400 = high). However, once a patient is on treatment, LDL level, blood pressure, diabetes control, and symptoms are more actionable than changes in CAC alone.