Statin Therapy Linked to Increased Coronary Plaque Calcium Density indicating plaque stabilisation on CTA: Study

A new study published in the journal of JACC: Cardiovascular Imaging showed that in asymptomatic people with a moderate risk of coronary artery disease (CAD), taking statins was linked to a decrease in non-calcified plaque (NCP) and a change towards denser calcium within coronary plaques seen on successive coronary CT angiography (CTA).

Coronary CTA allows for the measurement of changes in the composition of calcified plaque. Hence, this research investigated whether the growth in both volume and density of coronary calcified plaque due to statin therapy could serve as an indicator of plaque stabilization in asymptomatic individuals undergoing consecutive coronary CTA scans.

In the CAUGHT-CAD study, individuals without symptoms, who had not taken statins before and were at intermediate risk, were divided into a group receiving a preventive treatment strategy that included statins, and the other receiving standard care. The participants had a coronary CTA scan at the beginning of the study and after 3 years. In this additional examination, the amounts of 5 different types of plaque were calculated: noncalcified (≤350 HU), low-density calcium (351-500 HU), intermediate-density calcium (501-700 HU), high-density calcium (701-1000 HU), and very high-density calcium (>1,000 HU). The main focus was on the change in volumes of calcified plaque subtypes per lesion.

A total of 840 lesions were analyzed from 338 individuals (average age: 58.3 ± 6.9 years, 57.1% male, 161 [47.6%] taking statins). The use of statins was linked to increased advancement in intermediate-density (β = 0.89, SE = 0.39; P = 0.02) and high-density (β = 0.79, SE = 0.24; P = 0.001) calcium, while there was a reduction in noncalcified plaque (β = −9.83, SE = 1.64; P < 0.001) when considering cardiovascular risk elements, low-density lipoprotein cholesterol (LDL-C) level, and initial plaque size.

In those treated with statins, a drop of LDL-C by at least 30% was connected to more significant advancement in high-density (β = 1.11, SE = 0.49; P = 0.03) and very high-density (β = 1.68, SE = 0.85; P = 0.04) calcium.

In individuals without symptoms but at a moderate risk for CAD, the use of statin medication is linked to a change towards increased density of calcium within specific plaques in the coronary arteries. The potential of using calcium density measurements obtained through quantitative coronary computed tomography angiography as an effective indicator of how individuals respond to treatment or the stabilization of plaques on an individual level is yet to be confirmed.

Reference:

Vasanthakumar, S. A., Nicholls, S. J., Nerlekar, N., Marwick, T. H., & Lin, A. (2026). Calcium density as a marker of coronary plaque stabilization in primary prevention: The CAUGHT-CAD trial. JACC. Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2026.07.029