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Introduction With the integration of CT scanners into PET systems for attenuation correction, a coronary artery calcium (CAC) scan can now be obtained during Rb-82 PET scans. This provides a simple, fast, low-radiation opportunity to detect CAC, improve risk stratification, and aid Rb-82 PET interpretation. CAC is diagnostic of coronary artery disease (CAD), for which European and American guidelines recommend statin therapy unless contraindicated. However, because Rb-82 PET/CT is primarily requested to assess for myocardial ischaemia or infarction rather than CAC, we hypothesised that after Rb-82 PET/CT, patients with CAC may be undertreated with statin therapy.Methods For the pre-intervention audit, we retrospectively analysed 8,437 consecutive Rb-82 PET/CT scans from 2021–2024. A CAC scan was performed in 2,437 (28.8%) scans, of which 1,677 (68.8%) showed CAC. Of these, 309 (18.4%) patients were not prescribed a statin, including 23 (7.4%) who had a documented statin intolerance. This left 286 patients with CAC on their Rb-82 PET/CT who were not prescribed a statin and had no documented intolerance. For these patients, we assessed whether (i) CAC or CAD were documented in the post-scan clinical review, (ii) statin therapy was recommended in that review, and (iii) statins were prescribed at their most recent outpatient appointment. Then, for patients with CAC who were not prescribed a statin, we incorporated a recommendation into their Rb-82 PET/CT report advising the requesting clinician to consider statin therapy. We then repeated the audit using the same outcome measures post-intervention.Results In the pre-intervention audit, of the 286 patients with CAC who were not prescribed a statin and had no documented intolerance, the first post-scan clinical review documented the Rb-82 PET/CT diagnosis of CAC or CAD in 176 patients (61.5%). A statin was recommended in 119 patients (41.6%) and was currently prescribed at their most recent follow-up in 162 (56.6%). After adding the report-level recommendation for the requesting clinician to consider statin therapy (n = 16), documentation of CAC or CAD was present and a statin prescribed in 14 patients (87.5%). Hence, implementation of the Rb-82 PET/CT report recommendation was associated with a 55% relative increase in statin prescription versus usual care (RR = 1.55; p = 0.017).Conclusion Statin undertreatment after Rb-82 PET/CT-diagnosed CAD is common despite low intolerance rates. Implementing a concise recommendation into the Rb-82 PET/CT report for patients with CAC substantially improved clinician documentation and statin prescription rates. While larger studies should assess durability and generalisability, these findings suggest embedding a recommendation for statin therapy in Rb-82 PET/CT scan reports that identify CAC may offer a practical way to align post-scan care with guideline-directed statin therapy.