Statin-Induced Decade-Long Stabilization of Noncalcified Coronary Plaque Despite a Zero Calcium Score

A 48-year-old man with a coronary artery calcium (CAC) score of 0 underwent serial artificial intelligence (AI)-assisted coronary computed tomography angiography (CCTA) from 2015 to 2026, which revealed progressive noncalcified plaque.

Despite the absence of baseline calcification, serial imaging demonstrated increasing plaque volume before initiation of high-intensity rosuvastatin (20 mg daily). After treatment, low-density lipoprotein fell from 143 to 62 mg/dL, and plaque-volume growth slowed from ∼18.6% to 12.6% per year. A minute calcific focus (0.8 mm³) appeared in 2025, consistent with early stabilization.

This longitudinal single-patient study provides imaging-based evidence that intensive statin therapy can decelerate noncalcified plaque progression, even in the absence of baseline calcium, as measured by quantitative AI-CCTA.

This is the first human case documenting statin-mediated slowing of noncalcified plaque in a CAC 0 patient with decade-long serial CCTA.

AI-quantified CCTA reveals subclinical atherosclerosis invisible to CAC 0 scoring and enables plaque-directed therapy monitoring in individual patients.