Statins increase coronary artery calcification scores over time by promoting plaque stabilization and reducing lipid content, and they significantly reduce cardiovascular events in patients with elevated coronary artery calcification, indicating that the progression of calcification does not negate the clinical benefit of statins.

Statins reduce cholesterol in artery walls, which causes immune cells and muscle cells in the artery to change into bone-like cells. These cells release tiny bubbles that trap calcium and phosphate, forming hard mineral deposits. Over time, these deposits grow and make the artery walls stiffer, which shows up as higher calcium scores on scans. Even though the arteries become more calcified, the plaques turn from soft and rupture-prone into hard and stable structures that are less likely to cause heart attacks.