Major trial challenges how doctors decide who really needs statins
A major clinical trial presented in a Hot Line session at ESC Congress 2026 has questioned how doctors decide who should take statins to prevent heart attacks and strokes. In the CorCal Outcomes trial, using heart scans to measure coronary artery calcium produced the same observed rate of major cardiovascular events as traditional risk scoring, even though the scans led to far fewer recommendations to start statins. Patients advised to take the drugs because of calcium buildup were nearly three times as likely to stick with treatment. The study did not prove the scan strategy is as effective as conventional assessment; researchers say more work is needed before it can be judged a better way to prevent cardiovascular disease.
Atherosclerotic cardiovascular disease, driven by plaque in the arteries, remains a leading cause of illness and death worldwide. Doctors usually estimate risk from factors such as smoking, diabetes, high blood pressure and cholesterol, then consider statins, which lower LDL cholesterol. Many first heart attacks, especially in younger adults, still occur in people who would not have been classified as high enough risk to treat. Principal investigator Doctor Joseph B. Muhlestein of Intermountain Medical Center in Murray, United States, described a gap in risk assessment, statin initiation and persistence.
The trial compared the pooled cohort equations, which estimate risk from age, cholesterol, blood pressure and smoking, with coronary artery calcium measured by computed tomography as a marker of existing plaque. It enrolled 5,772 patients with no known prior disease from the Canyons and Desert regions of Intermountain Health Care in the United States.
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