Researchers found no significant difference in major cardiovascular events when statin therapy decisions were based on coronary artery calcium measurement compared with traditional risk factor assessment, according to results presented at ESC Congress 2026. The CorCal Outcomes trial compared two methods for identifying patients who should receive statin therapy to prevent a first cardiovascular event: the pooled cohort equations based on traditional risk factors and coronary artery calcium scoring using computed tomography scans.
The study enrolled 5,772 patients without known atherosclerotic cardiovascular disease who were randomly assigned to receive statin recommendations based on either their traditional risk score or their calcium score. After 4.2 years of follow-up, major cardiovascular events occurred in 2.7% of patients in both groups, and the study did not meet its noninferiority criterion.
The trial revealed different patterns in the two approaches. Patients in the traditional risk score group received recommendations to start statins more than three times as frequently as those in the calcium score group. However, patients recommended statins based on calcium scoring showed much higher medication adherence, with 62% persisting with treatment compared with 23% in the traditional risk group.
The researchers noted that the study's power to detect a difference was reduced by lower-than-expected event rates. "The study did provide important hypothesis-generating insights into the efficiency of statin initiation and adherence when decisions are based on CAC scoring," said Dr. Joseph B. Muhlestein, principal investigator from Intermountain Medical Center. The 2025 Focused Update of ESC/EAS Guidelines recommends that increased coronary artery calcium score, if measured, should be considered as a risk modifier in individuals at moderate risk.
