Statins are among the most commonly prescribed medications in cardiovascular care—and for good reason. Backed by decades of research, statins have been shown to prolong life by reducing the risk of heart attack, stroke, and other complications of atherosclerosis. But how exactly do they work?
Let’s break it down.
Statins and Plaque: More Than Just Lowering Cholesterol
While statins are widely known for lowering LDL cholesterol, their benefits go far beyond that. One of their most important functions is how they impact plaque inside the arteries—the real culprits behind heart attacks.
Atherosclerotic plaque builds up over time in the walls of blood vessels. This plaque comes in different forms:
It’s the non-calcified (soft) plaque that poses the greatest danger. These are the unstable plaques most likely to rupture, causing the formation of a blood clot that can lead to a heart attack or stroke.
What Statins Actually Do
Here’s where statins shine. Statins:
This last point surprises many people. As statins "melt" or reduce the soft, dangerous plaque, what’s left behind often calcifies, forming a more stable “scar.” This calcified plaque is less likely to rupture—making it much safer from a clinical standpoint.
Why Your Calcium Score Might Go Up—And Why That’s Not Always Bad
One important thing to understand: if you’ve had a coronary artery calcium (CAC) score done in the past and you’ve been on statin therapy for a while, your follow-up calcium score might actually increase. That’s not necessarily a sign that things are getting worse.
In fact, it can be a reflection of the healing process—the transformation of high-risk non-calcified plaque into lower-risk, calcified plaque. This is one of the reasons why advanced imaging, like coronary CT angiography (CCTA), is helpful. It shows both calcified and non-calcified plaque and provides a more complete picture than calcium scoring alone.
The Takeaway
Statins save lives, not just by lowering cholesterol, but by transforming dangerous, unstable plaque into stable, calcified remnants. This stabilizing effect is a cornerstone of preventative cardiology and is why statins remain a key treatment for patients with elevated cardiovascular risk.
If you’re considering a statin—or have questions about your calcium score and plaque progression—speak with your healthcare provider or schedule a consultation with our cardiovascular imaging team. We can help you understand how your arteries are responding and what steps you can take to protect your heart.
