SALT LAKE CITY — A large-scale clinical study underway in the United States is reshaping how doctors may soon decide which patients are most likely to benefit from statin therapy—a common medication used to lower cholesterol and prevent coronary heart disease. The research, led by experts at Intermountain Health in Salt Lake City, is testing the use of coronary artery calcium (CAC) scoring as a more precise method for evaluating cardiovascular risk, moving beyond the conventional models based solely on demographic and clinical risk factors.
At the heart of this approach is a non-invasive, low-radiation CT scan that measures calcium buildup in the arteries. The CAC score, derived from the scan, reflects the amount of calcified plaque within coronary arteries. These plaques, if left unchecked, can obstruct blood flow and lead to heart attacks, strokes, or death.
Dr. Jeffrey L. Anderson, a leading cardiovascular researcher and the study’s principal investigator, said the research is meant to refine the decision-making process around prescribing statins. While traditional guidelines use risk calculators based on age, cholesterol levels, blood pressure, and other health factors, Anderson and his team believe direct imaging of arterial plaque could provide a more accurate assessment.
“We’re aiming to determine whether visual evidence of atherosclerosis offers clearer guidance than mathematical models,” said Anderson. “Not every patient with elevated risk factors ends up with coronary plaque, and not every patient with plaque has easily identifiable risk factors. The CAC score offers an opportunity to close that gap.”
Large Study with Broad Implications
The study has enrolled more than 5,600 participants, making it one of the largest of its kind. Patients were divided into groups and assessed using both traditional risk equations and CAC imaging. Physicians received letters containing individual CAC results along with treatment recommendations—highlighting whether a statin prescription was warranted based on the imaging outcomes.
What emerged from the early phase of the research was a marked difference in prescription rates between patients evaluated with CAC data and those who were not. Despite having similar clinical risk profiles, the inclusion of CAC imaging led to significant shifts in physician recommendations.
“These early findings suggest that the presence—or absence—of coronary calcium has a strong influence on prescribing behavior,” said Anderson. “It changes how physicians see the patient’s true risk.”
CAC Scoring vs. Traditional Risk Equations
Traditional tools such as the ASCVD risk calculator estimate the 10-year risk of a major cardiovascular event. However, these methods can sometimes overestimate or underestimate true risk, particularly in patients at borderline or intermediate levels. CAC scoring, by contrast, provides direct evidence of disease.
In this study, the research team is investigating whether statin use guided by CAC scores leads to better long-term outcomes—including reductions in cardiovascular deaths, myocardial infarctions, strokes, and procedures like angioplasty or bypass surgery. The study is designed to follow participants for up to seven years, with an average follow-up period exceeding four years.
According to Anderson, this duration will allow researchers to evaluate whether CAC-based treatment strategies lead to measurable improvements in patient health when compared to standard care.
Balancing Benefits and Risks
While statins are widely used and generally effective, their use is not without risks. Some patients report muscle pain, while others face a slightly increased risk of developing diabetes. For these reasons, experts stress the importance of accurately identifying individuals who are most likely to benefit from the medication.
“This isn’t about prescribing fewer statins or more statins—it’s about prescribing them to the right patients,” said Anderson. “By tailoring treatment based on real plaque burden, we can be more confident that the benefits outweigh the potential harms.”
The study’s ultimate goal is to help refine clinical guidelines and offer clearer direction to physicians managing patients with borderline or uncertain risk levels. If CAC scoring proves superior, it could lead to wider adoption of imaging-based risk assessment in primary care and cardiology practices across the country.
Growing Role of Imaging in Cardiovascular Prevention
CAC scoring has been gaining traction in recent years as a non-invasive, cost-effective tool for cardiovascular risk evaluation. Major professional organizations, including the American College of Cardiology (ACC) and American Heart Association (AHA), already support its use in certain clinical scenarios, particularly when treatment decisions are unclear.
The findings from the Intermountain study, presented at the ACC’s Annual Scientific Sessions in Chicago, add further weight to that momentum. With long-term outcome data on the horizon, the research could become a milestone in the evolution of preventive cardiology.
The ability to personalize statin therapy using CAC imaging not only enhances precision medicine but may also help avoid unnecessary medication in low-risk individuals—reducing healthcare costs and improving patient quality of life.
What Happens Next
With final results expected in early 2026, the next steps will involve comprehensive analysis of clinical outcomes between the CAC-guided and traditionally guided groups. Researchers will look at key indicators like:
- Cardiovascular-related mortality
- Non-fatal heart attacks
- Stroke incidence
- Rates of invasive interventions such as angioplasty or coronary bypass surgery
These outcomes will determine whether CAC-based screening leads to better protection against life-threatening cardiovascular events and whether such an approach should be adopted in broader clinical practice.
Until then, the study continues to underscore the evolving nature of risk assessment and personalized treatment in cardiovascular care. If confirmed, this method could mark a major step forward in how preventive cardiology is practiced worldwide.
The Intermountain Health study represents a significant advance in the search for more effective, personalized methods of prescribing statins. By using coronary artery calcium scoring to directly measure plaque burden, researchers are hoping to improve the accuracy of cardiovascular risk assessment and ensure that only those who truly need statins receive them. As the study progresses toward its 2026 completion, it may well reshape the standard of care for millions at risk of heart disease.
