No Event Differences With Coronary Calcium–Guided Statin Strategy

Using coronary artery calcium (CAC) scores to guide statin recommendations produced no observed difference in major cardiovascular events compared with traditional risk assessment based on pooled cohort equations (PCE) in the randomized CorCal Outcomes trial.

The study enrolled 5,772 adults without known atherosclerotic cardiovascular disease, diabetes, or prior statin therapy from 2 US regions served by Intermountain Health Care. Mean age was 64 years, and 51% were women. Participants and their physicians received a protocol-directed recommendation based on either the participant’s PCE risk score or CAC score, with the final treatment decision left to them.

After 4.2 years, the primary composite endpoint of all-cause death, myocardial infarction, stroke, or arterial revascularization occurred in 2.7% of each group. The hazard ratio was 0.99 (95% CI, 0.71-1.38). The trial did not meet its noninferiority criterion, and investigators attributed its reduced statistical power to lower-than-expected event rates.

PCE-based assessment generated a recommendation to initiate statin therapy more than 3 times as frequently as CAC-based assessment. However, among participants advised to take a statin, medication adherence was 62% when the recommendation was based on CAC and 23% when it was based on PCE risk.

Investigators said the study did not establish the CAC-guided strategy as noninferior but generated hypotheses about the efficiency of statin initiation and adherence. They said the findings could inform an additional adequately powered randomized trial comparing CAC guidance with current risk factor–based algorithms.

Source: European Society of Cardiology. New data presented on the use of coronary artery calcium for cardiovascular risk assessment. News release. Published August 31, 2026. Accessed September 1, 2026.