Lee SE, et al. - Using a prospective multinational registry, researchers investigated if statin use impacts how coronary artery calcium score (CACS) progression represents compositional plaque volume (PV) progression. Of overall 2,252 consecutive patients who were examined using serial coronary computed tomography angiography (CCTA) at a ≥ 2-year interval, they included in this study 654 patients (61 ± 10 years, 56% men, inter-scan interval 3.9 ± 1.5 years) with available data on the use of statins and having a serial CACS. They used multivariate linear regression models to determine the link between compositional PV change and change in CACS in both statin-taking (n=408) and non-statin group (n=246). The progression of both non-calcified and calcified PV progression was indicated by CACS progression in the non-statin group, but only calcified PV progression, not non-calcified PV progression, was indicated by CACS progression in the statin group. Results of serial CACS should be interpreted differently according to statin use.