Coronary atherosclerosis is a leading cause of death in the United States and worldwide, accounting for close to 1 million deaths annually in the United States alone. The evaluation of coronary disease by CT-derived calcium scores is a rapidly evolving field of medical imaging. Furthermore, until recently, whether or not regression or progression of coronary disease could accurately be assessed by coronary calcium scores had been a question of considerable debate among experts in this field. If the medical treatment of coronary artery disease by statin pharmacotherapy could be accurately assessed by coronary calcium scoring, this would take much of the current guess work out of statin pharmacotherapy. Initial retrospective studies and observational data suggested that statin treatment resulted in reduction of coronary calcium. More recently, five randomized controlled trials have demonstrated that not only does statin treatment not reduce coronary calcium, but in fact, the progression of coronary calcium by CT scanning is indistinguishable from placebo treatment.