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Introduction CT scanners integrated into PET systems for attenuation correction enable coronary artery calcium (CAC) detection during Rb-82 PET scans, offering a fast, low-radiation opportunity to improve risk stratification. CAC is diagnostic of coronary artery disease (CAD), for which guidelines recommend statin therapy unless contraindicated. Since Rb-82 PET/CT is primarily requested to assess myocardial ischaemia, we hypothesised that patients with incidentally identified CAC may be undertreated with statins.Methods We retrospectively analysed 8,437 consecutive Rb-82 PET/CT scans (2021–2024). Of 2,437 scans (28.8%) with a CAC study, 1,677 (68.8%) showed CAC. Of these, 309 (18.4%) were not prescribed a statin, and excluding 23 with documented intolerance, 286 patients remained for analysis. We assessed whether CAC/CAD was documented post-scan, whether statins were recommended, and whether they were prescribed at most recent follow-up. An intervention was then introduced: a report-level recommendation advising requesting clinicians to consider statin therapy for patients with CAC not already prescribed one.Results Pre-intervention, of 286 eligible patients, CAC/CAD was documented in 176 (61.5%), statins were recommended in 119 (41.6%), and prescribed at follow-up in 162 (56.6%). Post-intervention (n=16), CAC/CAD documentation and statin prescription were present in 14 patients (87.5%), representing a 55% relative increase versus usual care (RR=1.55; p=0.017).Conclusion Statin undertreatment following Rb-82 PET/CT-diagnosed CAC is common despite low intolerance rates. A concise report-level recommendation substantially improved documentation and prescription rates, suggesting this practical intervention could help align post-scan care with guideline-directed statin therapy at scale. Which of the following was shown to improve statin prescription in patients with coronary artery calcium present on Rb82-PET scan?A: Routine cardiology referralB: Patient-facing educational leafletsC: Report-level statin recommendation (correct)D: Repeat CAC scanning at 12 monthsE: Increasing statin dose in already-treated patients