Statins and Your Calcium Scores

A woman sitting on a park bench with heart pain

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Healthcare providers sometimes use a calcium score to help decide whether to recommend treatment with a statin.

A “calcium scan” is an X-ray technique used to assess the amount of calcium deposits in the coronary arteries, which indicates that atherosclerosis is present. Statins are used to treat high cholesterol and prevent coronary artery disease that leads to heart attacks.

However, in some people, the calcium score increases with statin therapy. This is a point of controversy and concern among cardiologists (heart experts).

This article explains why statins are used and what their relationship to your calcium score may mean. It also covers why there's some evidence to suggest a rise in the score may actually indicate a treatment benefit.

What Do Calcium Scores Mean?

A calcium score of zero, measured in the coronary arteries, means there is no identifiable disease. You have a low risk for cardiovascular incidents like heart attack, stroke, or related death in the next 10 years. Your healthcare provider may assess treatment with statins on the basis of this score, as well as other factors. Calcium score ranges also include:

  • 1 to 99: mild disease
  • 100 to 399: moderate disease
  • 400 or higher: severe disease

Why Statins Are Prescribed

Statin drugs like Lipitor (atorvastatin) are used to treat your cholesterol level but also any plaque buildup in the walls of your arteries due to atherosclerosis. These plaques can grow large enough to partially block the artery and produce symptoms, such as angina or claudication.

Claudication occurs when poor blood flow due to arterial disease leads to symptoms of pain and weakness in the legs when you walk.

The real problem with these plaques is that they can suddenly rupture, causing a sudden occlusion (blockage) of the artery—which often leads to a heart attack or a stroke.

Plaques are deposits of several materials, including lipids, inflammatory cells, fibrotic cells, and calcium. It is the calcium in atherosclerotic plaques that is detected by a cardiac calcium scan—the higher the calcium score, the more extensive is atherosclerosis.

Statins and the Calcium Score

Several studies have now shown that treating a patient who has atherosclerosis with statins can increase the cardiac calcium score, even though elevated scores are cause for concern and often the reason for treating with statins in the first place.

In 2015, a study was published in the Journal of the American College of Cardiology which helps to clarify what this increase in calcium means.

Investigators reviewed eight separate studies which had used intravascular ultrasound (IVUS, a catheter technique) to assess the size and composition of atherosclerotic plaques in patients treated with statins. They found two things:

  • High-dose statin therapy tended to shrink plaques.
  • While the plaques were shrinking, their composition was changing.

After statin therapy, the volume of lipid deposits within plaques diminished, and the volume of fibrotic cells and calcium increased. These changes—converting an unstable “soft” plaque to a more stable “hard” plaque—may render a plaque less prone to sudden rupture.

Researchers think this finding may be linked to the fact that statin therapy significantly reduces the risk of heart attacks in patients with coronary artery disease.

Statins and Higher Calcium Scores

Evidence supports the idea that statin therapy not only reduces cholesterol levels but also changes existing plaques to make them less dangerous. As part of this process, the plaques may become more calcified—and thus, the calcium score goes up. An increasing calcium score with statin therapy, therefore, may indicate treatment success, and should not be a cause for alarm.

While this theory is not settled science, at this point it best fits the available evidence.


A cardiac calcium scan can be a useful tool in assessing the presence or absence of coronary artery disease. If calcium is present, atherosclerosis is present—and aggressive lifestyle changes are in order. Statin therapy and other inventions, like taking a daily aspirin, may be prescribed.

But once statin therapy has begun, interpreting later calcium scans becomes more of a problem. If the calcium score goes up, it may not indicate worsening coronary artery disease, but rather, is likely to be a positive effect of statin treatment.

Talk with your healthcare provider about your screening calcium scan, and why it may be helpful if you are at some risk for coronary artery disease. Keep in mind, though, that higher calcium scores from repeat scans after statin therapy may actually indicate the statins are working.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.