A randomized trial of 5,772 US adults found heart-scan-guided statin advice produced the same 2.7% rate of major cardiovascular events as risk calculators, but it did not meet its statistical test for noninferiority.
The CorCal Outcomes trial, presented in a Hot Line session at ESC Congress 2026 in Munich on 31 August 2026, tested two ways of deciding who should be advised to start statins before a first heart attack or stroke. It enrolled 5,772 adults from Intermountain Health Care in the United States who had no known atherosclerotic cardiovascular disease, no diabetes and no prior statin use. Their mean age was 64 and 51% were women. They were randomly assigned 1:1 to guidance based on the pooled cohort equations, a standard risk calculator using age, cholesterol, blood pressure and smoking status, or to guidance based on a coronary artery calcium score from a CT scan.
After an average follow-up of 4.2 years, major cardiovascular events, a composite of death from any cause, heart attack, stroke and arterial revascularization, occurred in 2.7% of patients in each group (hazard ratio 0.99, 95% confidence interval 0.71 to 1.38). Patients assessed with the risk calculator were advised to take statins more than three times as often as those guided by calcium scans. Among those advised to take statins, 62% of the scan group followed the recommendation versus 23% in the calculator group. The final decision on statins remained with patients and their doctors.
The researchers stressed that identical observed event rates do not show the two strategies are equally effective. The trial did not meet its predefined requirement for noninferiority, which the authors attributed to lower-than-expected event rates, and principal investigator Joseph B. Muhlestein said the study did not demonstrate noninferiority between the groups. He noted that many first heart attacks, particularly in younger adults, occur in people not classed as high risk by conventional tools. Further studies are needed to determine whether calcium-scan-guided prescribing offers a better prevention strategy.
