Major trial challenges how doctors decide who really needs statins
A study of nearly 5,800 adults found that heart scans measuring calcium buildup in the arteries led to the same observed rate of major cardiovascular events as traditional risk assessments, despite recommending statins to far fewer patients. Surprisingly, patients advised to take statins based on their scans were nearly three times as likely to stick with their medication, raising intriguing questions about how…
Key points
- A trial of 5,772 patients found the same observed rate of major cardiovascular events with calcium scans and traditional risk scores.
- Calcium scan guidance led to more than three times fewer statin recommendations than traditional risk assessment.
- Patients advised statins after calcium scans were about 2.7 times as likely to follow their medication regimen.
A major clinical trial has raised new questions about how doctors decide who should take statins to prevent heart attacks and strokes. Researchers found that using heart scans to guide treatment produced the same observed rate of major cardiovascular events as traditional risk assessments, even though the scans led to far fewer recommendations to start statins. The findings were presented during a Hot Line session at ESC Congress 2026.
The CorCal Outcomes trial enrolled 5,772 patients from the Canyons and Desert regions of Intermountain Health Care in the United States. Participants had no known history of atherosclerotic cardiovascular disease or diabetes and had not previously received statin therapy. Their average age was 64, and women made up 51% of the study population.
How the trial was run
Participants were randomly assigned in equal groups. One group received statin guidance based on pooled cohort equations, a tool that estimates risk from factors such as age, cholesterol, blood pressure and smoking. The other group received recommendations based on coronary artery calcium measured by CT scan. Patients and their physicians were told the recommendations, but the final decision on starting statins stayed with patients and their doctors.
After an average follow-up of 4.2 years, 2.7% of patients in each group experienced one of the events in the study's primary outcome, which included death from any cause, heart attacks, strokes and procedures to restore blood flow. The trial did not establish that the scan approach was as effective as conventional risk assessment, and researchers say additional studies are needed.
For far too many patients, the first symptom of ASCVD is a heart attack
— Doctor Joseph B Muhlestein
Adherence and next steps
Patients assessed with traditional risk scores were recommended statins more than three times as often as those guided by calcium measurements. Among those advised to take statins, patients whose recommendations were based on calcium scans were approximately 2.7 times as likely to follow their regimen. The trial did not establish why adherence differed so much.
Doctor Joseph B Muhlestein of the Intermountain Medical Center in Murray, USA, the trial's Principal Investigator, said the study's power to detect a difference was reduced by lower-than-expected event rates. He said the data could be used to plan an additional well-powered randomized trial comparing calcium scoring with current risk factor-based algorithms.
